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South Dakota rates for HCPCS L1950

Ankle-foot orthosis (AFO), spiral, (Institute of Rehabilitative Medicine type), plastic, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $512.86 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $912.01 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $562.34 / $5,495.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $954.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $912.01 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $467.74 / $1,000.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14