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South Dakota rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $812.83 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $588.84 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,698.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,000.00 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $616.60 / $6,165.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,202.26 / $1,202.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,737.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $977.24 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $549.54 / $1,174.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13