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South Dakota rates for HCPCS L4110

Replace Leather Cuff Kafo-Afo, Calf Or Distal Thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.38 / $66.38 / $66.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.76 / $66.17 / $66.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.81 / $61.81 / $111.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.63 / $111.64 / $138.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.37 / $111.83 / $510.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $61.70 / $113.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.83 / $111.64 / $183.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.44 / $113.22 / $213.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.75 / $94.53 / $112.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $64.39 / $105.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.42 / $96.42 / $96.42