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South Dakota rates for HCPCS L4398

Foot Drop Splint Recumbent Positioning Device Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $64.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.53 / $56.13 / $64.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $64.81 / $98.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $108.00 / $135.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.20 / $106.81 / $432.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.83 / $58.93 / $98.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.70 / $98.27 / $159.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $99.65 / $187.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.11 / $90.28 / $107.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.51 / $61.50 / $98.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $84.87 / $84.87