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South Dakota rates for HCPCS L1844

Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,274.86 / $1,274.86 / $1,274.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.86 / $1,382.36 / $1,424.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.93 / $1,186.93 / $2,493.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,127.00 / $2,148.27 / $2,658.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,549.17 / $2,336.19 / $9,309.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.62 / $1,288.99 / $2,353.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,073.41 / $2,493.63 / $3,437.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,042.29 / $2,528.73 / $4,765.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.79 / $1,974.80 / $2,347.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.75 / $1,008.86 / $1,681.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,221.60 / $2,221.60 / $2,221.60