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South Dakota rates for HCPCS L1652

Hip Orthosis Bilateral Thigh Cuffs With Adjustable Abductor Spreader Bar Adult Size Prefabricated Includes Fitting And Adjustment Any Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.42 / $298.42 / $298.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.50 / $296.82 / $298.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.01 / $252.01 / $470.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.00 / $498.00 / $622.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.82 / $501.63 / $2,000.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.98 / $276.77 / $468.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.93 / $470.16 / $736.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.06 / $476.77 / $898.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.19 / $424.03 / $504.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.88 / $216.62 / $361.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.87 / $418.87 / $418.87