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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
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $81.28 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $213.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $147.91 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $93.33 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $158.49 / $158.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $263.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $147.91 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $74.13 / $154.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25