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South Dakota rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.56 / $266.56 / $266.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.69 / $227.73 / $266.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $398.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.91 / $444.75 / $555.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.74 / $339.28 / $1,533.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.63 / $183.41 / $385.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.57 / $398.77 / $552.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.58 / $404.38 / $762.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.00 / $280.98 / $334.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.39 / $167.47 / $239.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.27 / $355.27 / $355.27