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South Dakota rates for HCPCS L1090

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.24 / $84.24 / $84.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.51 / $76.25 / $84.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.47 / $75.47 / $114.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.63 / $140.63 / $175.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.25 / $128.86 / $539.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.43 / $71.09 / $122.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.39 / $114.71 / $198.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.06 / $116.35 / $219.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.02 / $108.93 / $129.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.34 / $60.10 / $122.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.19 / $102.19 / $102.19