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South Dakota rates for HCPCS L2128

Knee Ankle Foot Orthosis Fracture Orthosis Femoral Fracture Cast Orthosis Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.27 / $1,342.27 / $1,342.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.56 / $1,320.57 / $1,342.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.09 / $1,207.09 / $2,124.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,239.50 / $2,239.50 / $2,799.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,320.57 / $2,231.76 / $9,986.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.61 / $1,231.36 / $2,292.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,766.89 / $2,124.98 / $3,707.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,740.37 / $2,154.89 / $4,060.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.37 / $1,886.53 / $2,242.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.61 / $1,069.96 / $1,656.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.16 / $1,893.16 / $1,893.16