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South Dakota rates for HCPCS L2114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $524.81 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $389.05 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $660.69 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $416.87 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $758.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,174.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $660.69 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $363.08 / $776.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08