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South Dakota rates for HCPCS L1980

Ankle Foot Orthosis Single Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Single Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.02 / $338.02 / $338.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.12 / $304.75 / $338.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.20 / $273.20 / $504.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.00 / $564.00 / $705.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.43 / $515.03 / $2,218.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.60 / $284.16 / $503.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.49 / $504.50 / $793.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.21 / $511.60 / $964.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.86 / $435.35 / $517.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.51 / $240.65 / $490.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.47 / $449.47 / $449.47