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South Dakota rates for HCPCS L5728

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,398.83 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,467.37 / $9,120.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,187.76 / $19,054.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,311.31 / $3,311.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $6,165.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,467.37 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,137.96 / $3,090.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21