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South Dakota rates for HCPCS L1220

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), anterior thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.36 / $199.36 / $199.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.32 / $177.89 / $199.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.61 / $185.61 / $284.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.72 / $332.63 / $415.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.89 / $300.63 / $1,347.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.68 / $165.88 / $296.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.34 / $284.23 / $478.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.79 / $288.23 / $543.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.08 / $254.13 / $302.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.50 / $129.83 / $216.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.22 / $253.22 / $253.22