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South Dakota rates for HCPCS L1848

Knee orthosis (KO), double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.52 / $481.52 / $481.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.20 / $478.92 / $481.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.50 / $437.50 / $758.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.25 / $803.25 / $1,004.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.75 / $809.37 / $3,239.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.10 / $466.02 / $788.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.72 / $758.55 / $1,188.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.33 / $788.28 / $1,794.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.38 / $684.17 / $813.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.83 / $360.33 / $582.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.80 / $675.80 / $675.80