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South Dakota rates for HCPCS L2830

Addition to lower extremity orthosis, soft interface for molded plastic, above knee section

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.54 / $73.54 / $73.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.57 / $73.54 / $96.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.45 / $68.45 / $116.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.63 / $122.63 / $153.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.44 / $143.34 / $594.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.94 / $80.81 / $137.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $116.42 / $203.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.41 / $120.30 / $252.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.72 / $137.81 / $163.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.34 / $70.40 / $117.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.72 / $103.72 / $103.72