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South Dakota rates for HCPCS L1907

Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.08 / $471.08 / $471.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.77 / $468.52 / $471.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $742.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.00 / $786.00 / $982.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.52 / $791.80 / $3,157.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.05 / $455.91 / $767.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $742.04 / $1,162.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.74 / $752.50 / $1,418.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.70 / $669.32 / $795.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.58 / $341.93 / $569.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.09 / $661.09 / $661.09