go back

South Dakota rates for HCPCS L1120

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO), scoliosis orthosis, cover for upright, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.84 / $31.84 / $31.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.11 / $31.84 / $33.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.64 / $29.64 / $49.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.25 / $53.78 / $66.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.08 / $55.91 / $237.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.27 / $30.83 / $53.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.92 / $49.21 / $85.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.23 / $49.91 / $94.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.34 / $47.25 / $56.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.48 / $24.78 / $40.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.85 / $43.85 / $43.85