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South Dakota rates for HCPCS L2116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $478.63 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,513.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $512.86 / $5,623.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $933.25 / $933.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,445.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $794.33 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $446.68 / $954.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76