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South Dakota rates for HCPCS L2126

Knee Ankle Foot Orthosis Fracture Orthosis Femoral Fracture Cast Orthosis Thermoplastic Type Casting Material Custom- Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,068.97 / $1,068.97 / $1,068.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.47 / $1,035.60 / $1,068.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.96 / $842.96 / $1,483.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.50 / $1,783.50 / $2,229.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.60 / $1,590.89 / $7,102.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.53 / $965.65 / $1,601.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.88 / $1,483.96 / $2,588.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.33 / $1,504.83 / $2,835.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,263.65 / $1,479.44 / $1,758.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.97 / $755.79 / $1,259.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.07 / $1,322.07 / $1,322.07