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South Dakota rates for HCPCS L1846

Knee orthosis (KO), double 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
$979.51 / $979.51 / $979.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.51 / $755.88 / $957.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.42 / $840.60 / $1,384.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.81 / $1,634.25 / $2,042.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$864.37 / $1,448.05 / $6,648.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.74 / $805.98 / $1,493.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.10 / $1,384.41 / $2,415.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.83 / $1,403.88 / $2,645.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.73 / $1,234.82 / $1,467.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.62 / $732.52 / $1,115.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.38 / $1,233.38 / $1,233.38