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South Dakota rates for HCPCS L1945

Ankle-foot orthosis (AFO), plastic, rigid anterior tibial section (floor reaction), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $933.25 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,949.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $660.69 / $6,606.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $1,148.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,905.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,071.52 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $575.44 / $1,380.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29