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South Dakota rates for HCPCS L5845

Addition, endoskeletal knee-shin system, stance flexion feature, adjustable

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,812.37 / $1,812.37 / $1,812.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,680.51 / $1,812.37 / $2,136.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.83 / $1,207.83 / $2,368.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,508.38 / $2,508.38 / $3,135.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,609.54 / $3,610.19 / $10,094.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.47 / $1,455.08 / $2,361.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.33 / $2,368.44 / $3,709.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,939.76 / $2,401.80 / $4,526.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,824.65 / $2,136.21 / $2,539.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.06 / $1,285.78 / $1,818.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,110.08 / $2,110.08 / $2,110.08