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South Dakota rates for HCPCS L5724

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,746.86 / $1,746.86 / $1,746.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.00 / $1,746.86 / $1,849.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.13 / $1,349.13 / $2,417.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,417.63 / $2,417.63 / $3,022.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.04 / $2,337.06 / $9,687.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.36 / $1,259.55 / $2,511.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,009.76 / $2,417.07 / $3,476.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,979.59 / $2,451.09 / $4,618.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,579.46 / $1,849.16 / $2,198.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.68 / $1,259.55 / $2,150.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,153.39 / $2,153.39 / $2,153.39