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South Dakota rates for HCPCS L2114

Ankle Foot Orthosis Fracture Orthosis Tibial Fracture Orthosis Semi-Rigid Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.02 / $529.02 / $529.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.96 / $450.67 / $529.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $408.60 / $759.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.38 / $882.75 / $1,103.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.09 / $761.63 / $3,518.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.64 / $420.23 / $776.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.83 / $759.89 / $1,254.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.36 / $770.59 / $1,452.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.91 / $643.82 / $765.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.64 / $328.90 / $652.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.99 / $676.99 / $676.99