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South Dakota rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $48.98 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $58.88 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $97.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $95.50 / $165.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $66.07 / $616.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $97.72 / $97.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $186.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $75.86 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $57.54 / $87.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10