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South Dakota rates for HCPCS L2108

Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture cast orthosis, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $758.58 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,995.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,318.26 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $776.25 / $7,079.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,318.26 / $1,318.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $2,454.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $1,412.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90