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South Dakota rates for HCPCS L2037

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,388.30 / $1,388.30 / $1,388.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.78 / $1,282.72 / $1,388.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.51 / $1,172.51 / $2,064.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,316.38 / $2,316.38 / $2,895.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,282.72 / $2,167.80 / $9,934.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.55 / $1,196.08 / $2,227.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,716.25 / $2,064.08 / $3,600.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.50 / $2,093.14 / $3,944.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.20 / $1,832.46 / $2,178.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.55 / $1,248.18 / $2,197.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,838.91 / $1,838.91 / $1,838.91