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South Dakota rates for HCPCS L1940

Ankle-foot orthosis (AFO), plastic or other material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.68 / $407.68 / $407.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.62 / $368.08 / $407.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.88 / $372.88 / $671.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.25 / $680.25 / $850.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.95 / $643.66 / $3,004.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.96 / $355.14 / $669.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.04 / $671.13 / $1,069.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.66 / $680.58 / $1,282.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.74 / $544.10 / $646.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.96 / $370.61 / $645.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.91 / $597.91 / $597.91