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South Dakota rates for HCPCS L1260

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.95 / $78.95 / $78.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.54 / $58.26 / $78.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.02 / $71.02 / $93.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.65 / $131.63 / $164.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.26 / $98.46 / $457.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.96 / $55.64 / $101.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.95 / $93.75 / $163.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.79 / $95.07 / $179.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.09 / $83.23 / $98.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.96 / $65.06 / $130.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.53 / $83.53 / $83.53