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South Dakota rates for HCPCS L2116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.24 / $645.24 / $645.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.87 / $533.35 / $645.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.14 / $501.14 / $933.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.33 / $1,076.63 / $1,345.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.20 / $926.54 / $4,303.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.51 / $511.22 / $951.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.53 / $933.91 / $1,539.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.88 / $947.06 / $1,784.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.99 / $783.22 / $930.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.29 / $466.80 / $928.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.03 / $832.03 / $832.03