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South Dakota rates for HCPCS L0113

Cranial Cervical Orthosis Torticollis Type With Or Without Joint With Or

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.75 / $238.75 / $238.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.78 / $237.47 / $238.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.25 / $192.25 / $376.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.25 / $398.25 / $497.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.66 / $401.32 / $1,603.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.38 / $231.07 / $390.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.70 / $376.08 / $590.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.02 / $381.36 / $718.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.76 / $339.24 / $403.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.18 / $173.30 / $288.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.05 / $335.05 / $335.05