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South Dakota rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $24,547.09 / $24,547.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,882.50 / $21,379.62 / $25,703.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $32,359.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,884.42 / $33,884.42 / $41,686.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,442.29 / $29,512.09 / $77,624.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $19,498.45 / $144,543.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $31,622.78 / $31,622.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,359.37 / $32,359.37 / $32,359.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $26,302.68 / $52,480.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,547.09 / $29,512.09 / $38,904.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,481.54 / $18,620.87 / $30,902.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $28,183.83