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South Dakota rates for HCPCS L1720

Legg Perthes orthosis, trilateral, (Tachdijan type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.97 / $1,234.97 / $1,234.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.81 / $1,095.40 / $1,234.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.77 / $1,149.77 / $1,918.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,892.33 / $2,060.63 / $2,575.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.61 / $1,715.03 / $7,860.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.41 / $946.26 / $1,912.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,594.85 / $1,918.08 / $2,848.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.92 / $1,945.08 / $3,665.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.30 / $1,449.73 / $1,723.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.89 / $869.92 / $1,761.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.84 / $1,708.84 / $1,708.84