go back

South Dakota rates for HCPCS L5822

Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.06 / $1,771.06 / $1,771.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.24 / $1,771.06 / $2,207.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $1,367.82 / $2,248.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,451.38 / $2,451.38 / $3,064.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,512.30 / $2,295.91 / $10,228.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.60 / $1,503.72 / $2,425.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,869.41 / $2,248.28 / $3,922.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.97 / $2,279.92 / $4,296.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,885.64 / $2,207.61 / $2,624.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.40 / $1,440.95 / $2,425.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,003.01 / $2,003.01 / $2,003.01