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South Dakota rates for HCPCS L2112

Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $426.58 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $316.23 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $870.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $537.03 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $338.84 / $3,235.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $575.44 / $575.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $933.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $524.81 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $288.40 / $630.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86