go back

South Dakota rates for HCPCS L0220

Thoracic, rib belt, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.15 / $108.15 / $108.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.14 / $94.32 / $108.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.21 / $86.21 / $169.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.87 / $180.38 / $225.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.07 / $159.40 / $706.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.97 / $87.95 / $168.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.61 / $169.10 / $264.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.50 / $171.49 / $323.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.09 / $134.74 / $160.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.90 / $80.30 / $155.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.66 / $150.66 / $150.66