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South Dakota rates for HCPCS L1300

Other scoliosis procedure, body jacket molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,442.83 / $1,442.83 / $1,442.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.26 / $1,243.29 / $1,598.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.46 / $1,277.46 / $2,228.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,407.50 / $2,407.50 / $3,009.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,598.72 / $2,422.75 / $10,083.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.48 / $1,436.70 / $2,338.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,853.28 / $2,228.89 / $3,611.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,993.53 / $2,260.26 / $4,259.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.77 / $2,283.88 / $2,714.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.11 / $1,166.75 / $1,944.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,985.73 / $1,985.73 / $1,985.73