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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
$1,621.81 / $1,621.81 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,344.23 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $11,748.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $2,570.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $4,265.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $2,454.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87