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South Dakota rates for HCPCS L1025

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.15 / $130.15 / $130.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.25 / $96.03 / $130.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.11 / $89.11 / $154.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.07 / $217.13 / $271.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.03 / $162.29 / $757.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.97 / $89.54 / $166.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.49 / $154.54 / $269.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.56 / $156.69 / $295.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.18 / $137.19 / $163.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.97 / $93.45 / $196.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.68 / $137.68 / $137.68