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South Dakota rates for HCPCS L2034

Knee-ankle-foot orthosis (KAFO), full plastic, single upright, with or without free motion knee, medial-lateral rotation control, with or without free motion ankle, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,700.68 / $1,700.68 / $1,700.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,562.15 / $1,700.68 / $1,733.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,618.14 / $1,618.14 / $2,735.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,837.63 / $2,837.63 / $3,547.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,733.00 / $2,928.77 / $11,530.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.10 / $1,615.93 / $2,727.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,274.42 / $2,735.39 / $4,232.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,240.32 / $2,773.90 / $5,227.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.63 / $2,475.71 / $2,942.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.55 / $1,264.74 / $2,107.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,436.98 / $2,436.98 / $2,436.98