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South Dakota rates for HCPCS L2038

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.17 / $1,119.17 / $1,119.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.85 / $1,101.08 / $1,119.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,006.48 / $1,006.48 / $1,771.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,867.50 / $1,886.18 / $2,334.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,101.08 / $1,860.83 / $8,399.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.69 / $1,026.70 / $1,911.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,473.22 / $1,771.79 / $3,091.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,451.11 / $1,796.73 / $3,385.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,343.56 / $1,572.97 / $1,869.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.19 / $803.57 / $1,339.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,578.51 / $1,578.51 / $1,578.51