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South Dakota rates for HCPCS L5722

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,133.33 / $1,133.33 / $1,133.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.00 / $1,133.33 / $1,177.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $875.29 / $1,424.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,536.72 / $1,568.63 / $1,960.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$885.20 / $1,383.11 / $5,634.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.27 / $801.91 / $1,479.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.77 / $1,424.89 / $2,079.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.99 / $1,444.94 / $2,722.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.57 / $1,177.28 / $1,399.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.31 / $601.42 / $1,002.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.44 / $1,269.44 / $1,269.44