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South Dakota rates for HCPCS L2415

Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.70 / $101.70 / $101.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.50 / $101.19 / $101.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.70 / $81.70 / $160.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.50 / $169.50 / $211.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.19 / $171.01 / $681.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.97 / $94.34 / $159.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.21 / $160.19 / $250.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.19 / $162.46 / $306.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.46 / $144.55 / $171.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.07 / $76.09 / $155.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.72 / $142.72 / $142.72