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South Dakota rates for HCPCS L5312

Knee disarticulation (or through knee), molded socket, single axis knee, pylon, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,268.32 / $4,268.32 / $4,268.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,668.13 / $4,268.32 / $4,274.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,001.57 / $3,001.57 / $5,169.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,579.88 / $5,907.75 / $7,384.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,654.42 / $5,154.63 / $21,089.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.88 / $2,911.76 / $5,372.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,298.56 / $5,169.77 / $7,597.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,298.56 / $5,242.52 / $9,879.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,651.30 / $4,274.78 / $5,081.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.48 / $2,633.46 / $3,639.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,605.79 / $4,605.79 / $4,605.79