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South Dakota rates for HCPCS L5930

Addition, endoskeletal system, high activity knee control frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,403.48 / $3,403.48 / $3,403.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,152.61 / $3,403.48 / $3,999.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $2,282.71 / $4,443.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,710.75 / $4,757.85 / $5,888.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,022.53 / $4,312.89 / $19,065.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.44 / $2,724.01 / $4,617.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,694.45 / $4,443.21 / $7,010.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,639.02 / $4,505.75 / $8,490.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,415.87 / $3,999.13 / $4,753.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.03 / $2,724.01 / $3,405.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,958.49 / $3,958.49 / $3,958.49