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South Dakota rates for HCPCS L5790

Addition, exoskeletal system, above knee (AK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.83 / $753.83 / $753.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.08 / $753.83 / $842.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.20 / $582.20 / $975.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.25 / $1,043.25 / $1,304.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.24 / $1,132.68 / $4,473.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.81 / $574.05 / $1,024.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.03 / $975.39 / $1,656.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.86 / $989.13 / $1,863.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.86 / $842.77 / $1,001.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.11 / $574.05 / $899.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.99 / $868.99 / $868.99