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South Dakota rates for HCPCS L0974

Thoracic-lumbar-sacral orthosis (TLSO), full corset

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $120.23 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $302.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $204.17 / $380.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $128.82 / $1,258.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $234.42 / $234.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $363.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $199.53 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $223.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93