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South Dakota rates for HCPCS L5856

Addition To Lower Proximity Prosthesis Endoskeletal Knee-Shin System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,273.73 / $24,273.73 / $24,273.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,502.42 / $24,273.73 / $28,591.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $31,714.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,597.00 / $33,597.00 / $41,996.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,556.96 / $41,022.60 / $134,932.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,663.70 / $19,474.84 / $32,957.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,369.87 / $31,714.32 / $49,753.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,974.18 / $32,160.69 / $60,605.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,421.17 / $28,591.13 / $33,985.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,127.44 / $18,661.91 / $24,343.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,254.58 / $28,254.58 / $28,254.58