go back

South Dakota rates for HCPCS L5677

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.92 / $557.92 / $557.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.85 / $557.92 / $577.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $700.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.35 / $772.13 / $965.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.05 / $761.27 / $3,128.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.76 / $393.65 / $727.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.24 / $700.25 / $1,135.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.50 / $710.11 / $1,338.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.63 / $577.91 / $686.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.76 / $468.24 / $766.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.86 / $623.86 / $623.86