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South Dakota rates for HCPCS L1920

Ankle Foot Orthosis Single Upright With Static Or Adjustable Stop (Phelps Or Perlstein Type) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.91 / $343.91 / $343.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.42 / $338.63 / $343.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $246.11 / $433.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.75 / $573.75 / $717.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.80 / $507.52 / $2,095.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.49 / $300.68 / $495.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.23 / $433.24 / $755.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.28 / $439.35 / $888.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.21 / $483.76 / $575.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.41 / $315.76 / $569.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.97 / $385.97 / $385.97