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South Dakota rates for HCPCS L1690

Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,618.88 / $1,618.88 / $1,618.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,456.43 / $1,610.15 / $1,618.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.55 / $1,300.55 / $2,550.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,701.13 / $2,728.14 / $3,376.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,610.15 / $2,721.15 / $10,889.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.37 / $1,501.39 / $2,542.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,120.48 / $2,550.26 / $3,994.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,088.67 / $2,586.16 / $4,873.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.73 / $2,300.21 / $2,734.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.03 / $1,211.43 / $1,958.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,272.05 / $2,272.05 / $2,272.05