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South Dakota rates for HCPCS L5714

Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.77 / $440.77 / $440.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.77 / $446.47 / $594.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.42 / $340.42 / $629.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.13 / $616.23 / $762.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.29 / $618.70 / $2,588.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.69 / $397.22 / $653.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.19 / $629.24 / $963.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.28 / $638.09 / $1,202.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.14 / $594.90 / $707.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.10 / $333.94 / $506.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.60 / $560.60 / $560.60