go back

South Dakota rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.85 / $238.85 / $238.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.82 / $226.56 / $238.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $348.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.63 / $398.63 / $498.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.56 / $382.89 / $1,586.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.04 / $211.26 / $360.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.47 / $348.14 / $583.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.13 / $353.04 / $665.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.45 / $323.66 / $384.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.35 / $220.46 / $360.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.16 / $310.16 / $310.16