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South Dakota rates for HCPCS L4397

Static Or Dynamic Ankle Foot Orthosis Including Soft Interface Material Adjustable For Fit For Positioning May Be Used For Minimal Ambulation Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.49 / $140.49 / $140.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.90 / $124.19 / $140.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $213.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.38 / $236.72 / $292.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.68 / $231.90 / $939.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.97 / $133.53 / $221.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.46 / $213.42 / $346.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.80 / $221.78 / $522.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.44 / $196.03 / $233.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.43 / $104.94 / $202.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.32 / $184.32 / $184.32