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South Dakota rates for HCPCS L5830

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,009.06 / $2,009.06 / $2,009.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,945.30 / $2,009.06 / $2,224.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.54 / $1,654.54 / $2,741.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,780.63 / $2,780.63 / $3,475.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,849.50 / $2,661.24 / $12,123.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.33 / $1,514.96 / $2,849.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,279.65 / $2,741.66 / $4,370.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,245.44 / $2,780.26 / $5,239.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,899.73 / $2,224.12 / $2,643.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.33 / $1,814.65 / $2,758.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,442.57 / $2,442.57 / $2,442.57