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South Dakota rates for HCPCS L5850

Addition Endoskeletal System Above Knee Or Hip Disarticulation Knee Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.60 / $128.60 / $128.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.83 / $128.60 / $199.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $168.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $222.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.41 / $207.92 / $799.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.81 / $127.67 / $191.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.44 / $168.89 / $294.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.91 / $174.50 / $367.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.77 / $199.92 / $237.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.84 / $136.07 / $170.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.47 / $150.47 / $150.47