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South Dakota rates for HCPCS L1230

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), Milwaukee type superstructure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.49 / $558.49 / $558.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.30 / $558.49 / $581.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.16 / $400.16 / $704.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.88 / $931.88 / $1,164.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.32 / $851.25 / $3,392.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.49 / $488.91 / $851.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.74 / $704.45 / $1,228.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.83 / $725.62 / $1,526.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.05 / $831.30 / $988.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.16 / $372.74 / $707.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.60 / $627.60 / $627.60