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South Dakota rates for HCPCS L5676

Additions to lower extremity, below knee (BK), knee joints, single axis, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.30 / $364.30 / $364.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.46 / $364.30 / $525.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.77 / $271.77 / $478.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.38 / $504.38 / $630.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.81 / $559.05 / $2,350.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.62 / $344.13 / $537.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.80 / $478.43 / $834.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.18 / $485.16 / $964.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.69 / $525.29 / $624.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.90 / $326.92 / $447.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.24 / $426.24 / $426.24