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South Dakota rates for HCPCS L1000

Cervical-thoracic-lumbar-sacral orthosis (CTLSO) (Milwaukee), inclusive of furnishing initial orthotic, including model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,697.59 / $1,697.59 / $1,697.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.79 / $1,697.59 / $1,821.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.97 / $1,499.97 / $2,631.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,832.38 / $2,832.38 / $3,540.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,821.98 / $2,944.84 / $12,090.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.08 / $1,698.91 / $2,714.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,188.00 / $2,631.45 / $4,389.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,271.94 / $2,668.48 / $5,028.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,223.21 / $2,602.83 / $3,093.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.45 / $1,331.25 / $2,714.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.39 / $2,344.39 / $2,344.39