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South Dakota rates for HCPCS L1730

Legg Perthes orthosis, (Scottish Rite type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.58 / $1,042.58 / $1,042.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.08 / $880.37 / $1,042.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.34 / $1,057.34 / $1,541.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,628.04 / $1,739.63 / $2,174.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.71 / $1,475.51 / $6,718.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.82 / $814.11 / $1,537.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,281.79 / $1,541.57 / $2,446.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.57 / $1,563.28 / $2,945.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,065.35 / $1,247.26 / $1,482.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.07 / $706.21 / $1,061.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.40 / $1,373.40 / $1,373.40