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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
$1,445.44 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,238.72 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,288.25 / $12,022.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $2,238.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $4,168.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $2,238.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26