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South Dakota rates for HCPCS L5824

Addition, endoskeletal knee-shin system, single axis, fluid swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.17 / $1,674.17 / $1,674.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.99 / $1,674.17 / $2,396.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,408.48 / $1,408.48 / $2,099.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,317.13 / $2,317.13 / $2,896.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,622.38 / $2,492.53 / $9,898.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.58 / $1,456.38 / $2,454.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,746.07 / $2,099.94 / $3,532.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,901.35 / $2,129.51 / $4,399.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,047.13 / $2,396.67 / $2,848.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.00 / $1,224.36 / $2,040.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.86 / $1,870.86 / $1,870.86