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South Dakota rates for HCPCS L1836

Knee orthosis (KO), rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.92 / $78.92 / $78.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.23 / $91.69 / $94.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.68 / $76.68 / $146.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.38 / $112.49 / $139.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.69 / $154.96 / $469.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.76 / $95.95 / $170.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.33 / $147.21 / $199.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.13 / $158.31 / $308.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.15 / $108.91 / $135.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.78 / $83.59 / $135.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.50 / $130.50 / $130.50