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South Dakota rates for HCPCS L4100

Replace Leather Cuff Kafo, Proximal Thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.02 / $85.02 / $85.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $80.33 / $85.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.43 / $73.43 / $136.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.75 / $141.75 / $177.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.68 / $135.76 / $621.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $74.90 / $139.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.34 / $136.32 / $225.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.64 / $138.22 / $260.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.02 / $114.76 / $136.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.90 / $68.40 / $139.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.73 / $117.73 / $117.73