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Hip Orthosis, Pavlik Harness

South Dakota rates for HCPCS L1620

Hip orthosis (HO), abduction control of hip joints, flexible, (Pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated July 2026.

How much does Hip Orthosis, Pavlik Harness cost?

$132

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $132 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $155 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$132$102 to $200
FacilityA hospital or hospital-owned outpatient department$155$117 to $174

How much rates vary

Facilitymedian $155 · 10th to 90th $107 to $224Professionalmedian $132 · 10th to 90th $91 to $275
$50.0$100.0$200.0$500.0$1.0Kfacility $155professional $132

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$102.33
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$275.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$281.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$114.82
Typical High
$891.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$169.82
Typical High
$169.82
Midlands
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$269.15
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$87.10
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$114.82
Typical High
$223.87
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88

Where South Dakota sits

The same service costs 2.9 times more in Hawaii than in Nebraska. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

South Dakota $132 · 8th of 51
HI $204NE $70.79

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.