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South Dakota rates for HCPCS L1030

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.55 / $65.55 / $65.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.02 / $48.99 / $65.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.95 / $52.95 / $78.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.36 / $109.50 / $136.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.99 / $82.79 / $377.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.55 / $47.67 / $85.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.55 / $78.84 / $137.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.56 / $79.94 / $150.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.78 / $69.98 / $83.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.55 / $47.67 / $99.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.23 / $70.23 / $70.23