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South Dakota rates for HCPCS L5848

Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.33 / $1,087.33 / $1,087.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.21 / $1,087.33 / $1,281.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.63 / $724.63 / $1,420.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.88 / $1,504.88 / $1,881.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.62 / $1,837.59 / $6,045.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.83 / $872.95 / $1,416.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,181.49 / $1,420.96 / $2,225.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.76 / $1,440.95 / $2,715.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.68 / $1,281.58 / $1,523.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.00 / $771.39 / $1,091.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.94 / $1,265.94 / $1,265.94