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South Dakota rates for HCPCS L5726

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,079.69 / $2,079.69 / $2,079.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.99 / $2,038.96 / $2,079.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.19 / $1,606.19 / $2,676.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,661.47 / $2,878.50 / $3,598.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.28 / $2,670.93 / $11,048.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.79 / $1,388.84 / $2,781.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,225.37 / $2,676.39 / $4,006.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,191.98 / $2,714.05 / $5,114.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.58 / $2,038.96 / $2,423.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.58 / $1,388.84 / $1,850.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,384.42 / $2,384.42 / $2,384.42