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South Dakota rates for HCPCS L2010

Knee Ankle Foot Orthosis Single Upright Free Ankle Solid Stirrup Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis) Without Knee Joint Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.47 / $730.47 / $730.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.89 / $730.47 / $833.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.83 / $740.83 / $1,152.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.75 / $1,218.75 / $1,523.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.16 / $1,341.07 / $5,601.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.86 / $776.88 / $1,236.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.87 / $1,152.01 / $1,998.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.92 / $1,168.22 / $2,201.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.63 / $1,190.23 / $1,414.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.90 / $606.29 / $1,013.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.33 / $1,026.33 / $1,026.33