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South Dakota rates for HCPCS L4370

Pneumatic Full Leg Splint Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.04 / $197.04 / $197.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.61 / $140.51 / $197.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.11 / $150.11 / $233.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.37 / $328.88 / $411.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.47 / $269.50 / $1,107.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.94 / $148.69 / $252.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.52 / $233.95 / $408.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.86 / $237.24 / $447.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.60 / $227.81 / $270.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.08 / $123.79 / $252.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.05 / $202.05 / $202.05