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South Dakota rates for HCPCS L5611

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,619.75 / $1,619.75 / $1,619.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.75 / $1,730.18 / $2,517.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,226.77 / $1,226.77 / $2,438.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,241.75 / $2,264.17 / $2,802.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,514.90 / $2,618.69 / $10,120.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.52 / $1,530.09 / $2,416.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,027.54 / $2,438.48 / $3,711.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.87 / $2,472.79 / $4,659.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,150.73 / $2,517.96 / $2,993.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.39 / $1,286.33 / $2,143.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,172.46 / $2,172.46 / $2,172.46