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South Dakota rates for HCPCS L1920

Ankle-foot orthosis (AFO), single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $251.19 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $724.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $467.74 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $251.19 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $436.52 / $436.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $891.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $489.78 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $245.47 / $501.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05