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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
$1,258.93 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,023.29 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,691.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $13,489.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $2,089.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $3,090.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $2,290.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,995.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09