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South Dakota rates for HCPCS L5616

Addition to lower extremity, endoskeletal system, above knee (AK), universal multiplex system, friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,485.55 / $1,485.55 / $1,485.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.55 / $1,489.67 / $2,090.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $1,018.60 / $2,099.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,056.13 / $2,099.48 / $2,570.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,483.53 / $2,173.89 / $8,447.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.74 / $1,289.81 / $2,181.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.70 / $2,099.48 / $3,128.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,824.56 / $2,129.05 / $4,012.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.43 / $2,090.31 / $2,484.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.76 / $1,244.49 / $1,779.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.46 / $1,870.46 / $1,870.46