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South Dakota rates for HCPCS L5840

Addition, endoskeletal knee-shin system, four-bar linkage or multiaxial, pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,943.24 / $3,943.24 / $3,943.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.83 / $3,943.24 / $4,574.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,364.97 / $3,364.97 / $5,432.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,457.75 / $5,457.75 / $6,822.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,992.45 / $5,273.58 / $21,225.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,866.05 / $3,115.74 / $5,555.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,517.35 / $5,432.90 / $7,806.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,449.56 / $5,509.36 / $10,382.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,907.09 / $4,574.24 / $5,437.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,589.10 / $2,985.68 / $4,828.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,840.22 / $4,840.22 / $4,840.22