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South Dakota rates for HCPCS L1930

Ankle Foot Orthosis Plastic Or Other Material Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.90 / $210.90 / $210.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.78 / $160.06 / $198.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $342.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.75 / $351.75 / $439.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.86 / $336.04 / $1,417.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.88 / $193.49 / $341.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.89 / $342.65 / $511.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.62 / $347.47 / $654.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.62 / $284.06 / $337.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.10 / $155.12 / $241.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.27 / $305.27 / $305.27