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South Dakota rates for HCPCS L5910

Addition, endoskeletal system, below knee (BK), alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.10 / $364.10 / $364.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.28 / $364.10 / $566.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.20 / $281.20 / $478.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.00 / $504.00 / $630.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.60 / $588.65 / $2,291.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.51 / $361.44 / $547.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.58 / $478.17 / $834.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.94 / $494.05 / $1,039.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.46 / $566.01 / $672.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.80 / $289.14 / $515.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.01 / $426.01 / $426.01