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South Dakota rates for HCPCS L1910

Ankle-foot orthosis (AFO), posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.78 / $234.78 / $234.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.26 / $208.22 / $234.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.57 / $218.57 / $331.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.27 / $391.88 / $489.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.22 / $351.89 / $1,607.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.35 / $194.15 / $357.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.56 / $331.40 / $578.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.43 / $336.07 / $633.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.07 / $297.45 / $353.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.68 / $175.36 / $253.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.24 / $295.24 / $295.24