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South Dakota rates for HCPCS L2106

Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $457.09 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $812.83 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $489.78 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $851.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,380.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $758.58 / $1,023.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $426.58 / $977.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58