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South Dakota rates for HCPCS L1950

Ankle Foot Orthosis Spiral (Institute Of Rehabilitative Medicine Type) Plastic Custom-Fabricated. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.83 / $643.83 / $643.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.90 / $620.63 / $643.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.34 / $524.34 / $964.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.38 / $1,074.38 / $1,342.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.63 / $1,048.85 / $4,501.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.69 / $578.70 / $995.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.08 / $964.63 / $1,610.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.03 / $978.21 / $1,843.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.29 / $886.61 / $1,053.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.87 / $697.73 / $1,065.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.40 / $859.40 / $859.40