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South Dakota rates for HCPCS L1050

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.00 / $84.00 / $84.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.92 / $64.12 / $84.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.68 / $71.68 / $103.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.57 / $140.25 / $175.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.12 / $108.36 / $496.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $59.79 / $111.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.79 / $103.18 / $180.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.50 / $104.64 / $197.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.25 / $91.60 / $108.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.64 / $51.95 / $77.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $91.92 / $91.92