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South Dakota rates for HCPCS L1810

Knee orthosis (KO), elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.18 / $86.18 / $86.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.79 / $70.84 / $84.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.33 / $88.85 / $124.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.63 / $143.63 / $179.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.76 / $127.72 / $587.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.32 / $73.17 / $131.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.14 / $124.04 / $212.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.60 / $125.78 / $237.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.88 / $111.09 / $132.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.34 / $61.45 / $94.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.50 / $110.50 / $110.50