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South Dakota rates for HCPCS L5859

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,671.20 / $14,671.20 / $14,671.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,603.77 / $14,671.20 / $17,292.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $19,172.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,306.25 / $20,306.25 / $25,382.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,894.84 / $29,224.88 / $81,836.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,054.58 / $11,779.01 / $19,924.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,941.82 / $19,172.79 / $30,135.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,116.70 / $19,924.38 / $45,530.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,770.71 / $17,292.83 / $20,555.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,134.23 / $11,287.32 / $14,723.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,081.21 / $17,081.21 / $17,081.21