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South Dakota rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,463.73 / $2,463.73 / $2,463.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.73 / $2,795.00 / $3,601.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $3,939.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,409.88 / $3,443.97 / $4,262.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,447.23 / $3,823.65 / $15,444.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.06 / $2,327.36 / $3,777.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,275.37 / $3,939.20 / $5,644.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,226.24 / $3,994.63 / $7,527.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,075.89 / $3,601.10 / $4,280.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.00 / $2,210.98 / $3,382.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,509.47 / $3,509.47 / $3,509.47