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South Dakota rates for HCPCS L2010

Knee-ankle-foot orthosis (KAFO), 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
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $660.69 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $676.08 / $9,120.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $1,148.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,230.27 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $602.56 / $1,122.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29