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South Dakota rates for HCPCS L2090

Hip-knee-ankle-foot orthosis (HKAFO), torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.26 / $416.26 / $416.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.75 / $375.41 / $416.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.54 / $387.54 / $601.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.50 / $694.50 / $868.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.41 / $634.44 / $2,619.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.79 / $350.06 / $600.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.49 / $601.92 / $948.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.97 / $610.39 / $1,150.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.10 / $536.29 / $637.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.97 / $273.98 / $456.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.27 / $536.27 / $536.27