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South Dakota rates for HCPCS L1020

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, kyphosis pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.21 / $90.21 / $90.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.18 / $66.56 / $90.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.99 / $83.99 / $107.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.13 / $150.38 / $187.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $112.50 / $528.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.79 / $62.78 / $115.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.07 / $107.12 / $186.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.72 / $108.63 / $204.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.23 / $95.10 / $113.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.79 / $64.78 / $136.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.43 / $95.43 / $95.43