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South Dakota rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Facilitymedian $398 · 10th–90th $380–$6760%20%40%10th90th$398Professionalmedian $380 · 10th–90th $234–$7080%20%10th90th$380$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $363.08 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $794.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $537.03 / $1,000.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $380.19 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $588.84 / $588.84
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $954.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $524.81 / $707.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $380.19 / $630.96
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81