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South Dakota rates for HCPCS L1830

Knee Orthosis Immobilizer Canvas Longitudinal Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $48.78 / $55.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.73 / $59.18 / $65.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $67.14 / $97.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.75 / $79.54 / $98.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.30 / $103.29 / $340.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.47 / $66.34 / $116.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.90 / $98.37 / $133.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.48 / $105.99 / $206.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $76.34 / $89.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.89 / $54.59 / $87.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.15 / $87.15 / $87.15