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South Dakota rates for HCPCS L1005

Tension Based Scoliosis Orthosis And Accessory Pads Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,679.48 / $2,679.48 / $2,679.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,069.05 / $2,410.63 / $2,679.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.75 / $2,326.75 / $4,221.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,470.75 / $4,470.75 / $5,588.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,665.08 / $4,503.99 / $17,957.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.17 / $2,485.06 / $4,208.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,509.78 / $4,221.10 / $6,611.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,457.12 / $4,280.53 / $8,066.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,251.99 / $3,807.25 / $4,525.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.70 / $1,944.98 / $3,307.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,760.62 / $3,760.62 / $3,760.62