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South Dakota rates for HCPCS L5812

Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.25 / $597.25 / $597.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.28 / $597.25 / $815.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.30 / $472.30 / $800.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.50 / $826.50 / $1,033.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.10 / $847.67 / $3,612.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.51 / $536.85 / $834.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.94 / $800.91 / $1,302.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.45 / $812.18 / $1,530.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.19 / $815.06 / $968.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.04 / $510.01 / $805.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.54 / $713.54 / $713.54