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South Dakota rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $18,620.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $16,595.87 / $19,952.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $25,118.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $26,302.68 / $32,359.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $22,908.68 / $60,255.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $15,135.61 / $112,201.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,417.38 / $24,547.09 / $24,547.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,118.86 / $25,118.86 / $25,118.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,417.38 / $20,417.38 / $40,738.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $22,908.68 / $30,199.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,912.51 / $14,454.40 / $23,988.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,877.62 / $21,877.62 / $21,877.62