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South Dakota rates for HCPCS L5716

Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.56 / $871.56 / $871.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.42 / $871.56 / $1,139.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $673.11 / $1,080.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.38 / $1,206.38 / $1,507.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.50 / $1,184.59 / $4,663.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.95 / $692.16 / $1,166.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$898.15 / $1,080.18 / $1,678.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.02 / $1,095.39 / $2,090.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.91 / $1,139.03 / $1,353.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.71 / $581.89 / $969.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.34 / $962.34 / $962.34