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South Dakota rates for HCPCS L5780

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic/Hydra Pneumatic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,341.85 / $1,341.85 / $1,341.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,341.85 / $1,347.14 / $1,430.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.33 / $1,036.33 / $2,015.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.38 / $1,857.38 / $2,321.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,252.09 / $1,714.78 / $7,109.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.57 / $917.61 / $1,785.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,675.81 / $2,015.44 / $2,637.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,577.43 / $2,043.82 / $3,851.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.66 / $1,347.14 / $1,601.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.57 / $1,032.93 / $1,842.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,795.58 / $1,795.58 / $1,795.58