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South Dakota rates for HCPCS L1710

Legg Perthes orthosis, (Newington type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,658.58 / $1,658.58 / $1,658.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.15 / $1,376.72 / $1,658.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.16 / $1,544.16 / $2,215.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,567.19 / $2,767.50 / $3,459.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.72 / $2,326.66 / $10,889.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.33 / $1,283.73 / $2,390.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,842.02 / $2,215.35 / $3,864.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,814.38 / $2,246.52 / $4,233.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.90 / $1,966.74 / $2,337.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.70 / $1,004.74 / $1,674.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,973.67 / $1,973.67 / $1,973.67