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South Dakota rates for HCPCS L2020

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$922.57 / $922.57 / $922.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.37 / $899.24 / $922.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.86 / $830.86 / $1,447.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.38 / $1,539.38 / $1,924.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.24 / $1,519.72 / $7,008.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.07 / $838.50 / $1,561.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,203.16 / $1,447.01 / $2,524.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.10 / $1,467.38 / $2,765.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.27 / $1,284.63 / $1,526.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.85 / $728.59 / $1,093.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.15 / $1,289.15 / $1,289.15