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South Dakota rates for HCPCS L2134

Kafo Fracture Orthosis Femoral Fracture Cast Orthosis Semi- Rigid Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.75 / $964.75 / $964.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.49 / $744.86 / $964.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.86 / $680.86 / $1,198.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.95 / $1,609.50 / $2,011.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$744.86 / $1,258.81 / $5,885.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.09 / $694.54 / $1,293.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.59 / $1,198.57 / $2,091.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.64 / $1,215.44 / $2,290.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.88 / $1,064.08 / $1,264.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.63 / $634.19 / $1,293.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.82 / $1,067.82 / $1,067.82