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South Dakota rates for HCPCS L5816

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.97 / $854.97 / $854.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.68 / $854.97 / $1,329.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.31 / $660.31 / $1,122.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,183.50 / $1,183.50 / $1,479.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.80 / $1,382.24 / $5,316.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.83 / $807.65 / $1,283.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.60 / $1,122.81 / $1,958.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.62 / $1,160.13 / $2,439.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.25 / $1,329.09 / $1,579.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.73 / $678.98 / $1,211.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.33 / $1,000.33 / $1,000.33