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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
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $954.99 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,659.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,513.56 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $8,128.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,479.11 / $1,513.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $2,754.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $870.96 / $1,288.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26