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South Dakota rates for HCPCS L2000

Knee Ankle Foot Orthosis Single Upright Free Knee Free Ankle Solid Stirrup Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.52 / $936.52 / $936.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.84 / $809.33 / $936.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.02 / $714.02 / $1,256.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.18 / $1,562.63 / $1,953.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.33 / $1,367.77 / $6,061.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.66 / $754.66 / $1,356.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,045.13 / $1,256.96 / $2,192.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.46 / $1,274.64 / $2,402.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.55 / $1,156.19 / $1,374.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.36 / $632.89 / $984.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.83 / $1,119.83 / $1,119.83