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South Dakota rates for HCPCS L1951

Ankle foot orthosis (AFO), spiral, (Institute of Rehabilitative Medicine-type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$703.06 / $703.06 / $703.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.87 / $679.71 / $703.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.11 / $710.11 / $1,107.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.00 / $1,184.73 / $1,466.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.31 / $1,181.83 / $4,711.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.54 / $652.05 / $1,104.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.94 / $1,107.58 / $1,734.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.13 / $1,123.18 / $2,116.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.29 / $999.01 / $1,187.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.10 / $510.35 / $867.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.76 / $986.76 / $986.76