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South Dakota rates for HCPCS L1700

Legg Perthes orthosis, (Toronto type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,302.49 / $1,302.49 / $1,302.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.07 / $1,182.84 / $1,302.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.63 / $1,212.63 / $2,071.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,173.13 / $2,173.13 / $2,716.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.75 / $1,987.56 / $9,141.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.40 / $1,096.63 / $2,065.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,722.17 / $2,071.21 / $3,301.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.32 / $2,100.36 / $3,958.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.07 / $1,680.10 / $1,997.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.04 / $952.88 / $1,430.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,845.26 / $1,845.26 / $1,845.26