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South Dakota rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,706.30 / $1,706.30 / $1,706.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.15 / $1,706.30 / $2,011.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $2,229.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.75 / $2,361.75 / $2,952.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,515.30 / $3,398.94 / $9,502.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.47 / $1,369.94 / $2,317.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,854.07 / $2,229.84 / $3,492.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.24 / $2,261.21 / $4,261.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,717.87 / $2,011.21 / $2,390.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.87 / $1,210.52 / $1,712.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,986.59 / $1,986.59 / $1,986.59