go back

South Dakota rates for HCPCS L1850

Knee Orthosis Swedish Type Prefabricated Off- The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.09 / $177.09 / $177.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.99 / $177.09 / $209.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.95 / $214.95 / $319.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.13 / $258.69 / $320.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.48 / $353.95 / $1,096.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.88 / $220.99 / $384.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.43 / $321.31 / $437.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.79 / $346.16 / $675.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.55 / $249.73 / $308.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.82 / $220.99 / $294.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.70 / $284.70 / $284.70