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South Dakota rates for HCPCS L2136

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.77 / $1,055.77 / $1,055.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.04 / $1,023.67 / $1,055.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.50 / $832.50 / $1,479.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,761.38 / $1,761.38 / $2,201.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.67 / $1,715.25 / $7,134.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.58 / $954.53 / $1,581.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.33 / $1,479.71 / $2,556.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.49 / $1,500.52 / $2,827.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.10 / $1,462.39 / $1,738.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.90 / $996.10 / $1,595.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.29 / $1,318.29 / $1,318.29