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South Dakota rates for HCPCS L1250

Addi To Thoracic-Lumbar-Sacral Orthotic (Tlso), (Low Profile), A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.20 / $66.20 / $66.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.13 / $55.64 / $66.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $61.62 / $89.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.75 / $110.63 / $138.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.64 / $94.03 / $434.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.43 / $54.14 / $96.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.45 / $89.53 / $156.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $90.79 / $171.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.89 / $79.48 / $94.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.79 / $45.08 / $67.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.76 / $79.76 / $79.76