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South Dakota rates for HCPCS L5814

Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,755.33 / $3,755.33 / $3,755.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,482.09 / $3,755.33 / $4,426.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.67 / $2,502.67 / $4,907.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,197.50 / $5,197.50 / $6,496.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.01 / $6,346.51 / $20,912.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.73 / $3,015.02 / $5,099.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,080.55 / $4,907.56 / $7,686.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,019.32 / $4,976.64 / $9,378.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,780.79 / $4,426.38 / $5,261.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,564.52 / $3,010.58 / $5,155.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,372.18 / $4,372.18 / $4,372.18