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South Dakota rates for HCPCS L1650

Hip orthosis (HO), abduction control of hip joints, static, adjustable, (Ilfled type), prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $154.88 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $426.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $295.12 / $549.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $173.78 / $1,479.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $302.00 / $302.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $524.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $295.12 / $389.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $147.91 / $309.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15