go back

South Dakota rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $389.05 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $524.81 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $630.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $891.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $501.19 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $288.40 / $602.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34