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South Dakota rates for HCPCS L5828

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.62 / $2,979.62 / $2,979.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,937.81 / $2,979.62 / $3,722.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $2,117.90 / $4,140.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,123.88 / $4,165.10 / $5,154.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,572.26 / $4,357.05 / $17,754.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.42 / $2,535.31 / $4,128.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,442.71 / $4,140.47 / $6,504.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,391.04 / $4,198.72 / $7,912.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,179.23 / $3,722.11 / $4,424.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,323.99 / $2,254.58 / $3,169.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,688.78 / $3,688.78 / $3,688.78