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South Dakota rates for HCPCS L1010

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, axilla sling

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.04 / $70.04 / $70.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.69 / $53.01 / $70.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.20 / $65.20 / $92.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.37 / $117.00 / $146.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.66 / $87.36 / $394.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.12 / $48.19 / $92.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.18 / $92.83 / $145.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.02 / $94.12 / $177.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $73.84 / $87.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.54 / $44.01 / $89.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.70 / $82.70 / $82.70