go back

South Dakota rates for HCPCS L5964

Addition Endoskeletal System Above Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,133.49 / $1,133.49 / $1,133.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.56 / $1,133.49 / $1,240.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.38 / $702.38 / $1,518.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,569.00 / $1,569.00 / $1,961.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.48 / $1,474.11 / $5,917.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.00 / $844.86 / $1,578.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,262.76 / $1,518.69 / $2,157.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.80 / $1,540.06 / $2,902.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.45 / $1,240.33 / $1,474.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.08 / $747.70 / $1,056.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.02 / $1,353.02 / $1,353.02