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South Dakota rates for HCPCS L4392

Replacement Soft Interface Material Static Afo

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.70 / $19.70 / $19.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.09 / $19.26 / $19.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.80 / $15.80 / $29.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $33.00 / $41.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.26 / $29.85 / $131.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $17.94 / $30.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.88 / $29.93 / $48.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.52 / $30.35 / $57.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.48 / $27.51 / $32.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.88 / $14.05 / $23.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.85 / $25.85 / $25.85