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South Dakota rates for HCPCS L1833

Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.75 / $404.00 / $404.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.49 / $428.86 / $471.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.67 / $465.67 / $674.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.63 / $572.29 / $708.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.35 / $706.71 / $2,424.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.87 / $444.97 / $812.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.46 / $678.61 / $925.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.64 / $732.34 / $1,430.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.58 / $549.97 / $571.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.12 / $379.36 / $569.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.04 / $601.04 / $601.04