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South Dakota rates for HCPCS L5818

Addition Endoskeletal Knee-Shin System Polycentric Friction Swing And Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.43 / $965.43 / $965.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.43 / $1,061.69 / $1,500.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.21 / $812.21 / $1,496.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,336.13 / $1,349.49 / $1,670.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$929.59 / $1,560.84 / $6,156.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.25 / $911.99 / $1,457.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,244.16 / $1,496.31 / $2,211.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.01 / $1,517.38 / $2,859.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,281.91 / $1,500.81 / $1,783.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.19 / $1,021.43 / $1,277.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.07 / $1,333.07 / $1,333.07