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South Dakota rates for HCPCS L4350

Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $81.00 / $81.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.43 / $63.26 / $76.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.22 / $73.06 / $110.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.37 / $135.00 / $168.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.84 / $110.45 / $535.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.11 / $66.98 / $119.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.11 / $110.77 / $193.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.73 / $112.34 / $211.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $98.34 / $116.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.34 / $58.62 / $116.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.67 / $95.67 / $95.67