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South Dakota rates for HCPCS L4394

Replace soft interface material, foot drop splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.37 / $14.37 / $14.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.45 / $14.04 / $14.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.40 / $13.40 / $21.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $24.00 / $30.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.04 / $23.54 / $96.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $13.10 / $21.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.14 / $21.80 / $35.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.87 / $22.12 / $41.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.14 / $20.05 / $23.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.20 / $10.74 / $20.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.82 / $18.82 / $18.82