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South Dakota rates for HCPCS L5973

Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $17,782.79 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $15,488.17 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $12,882.50 / $23,442.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,547.09 / $24,547.09 / $30,902.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $22,387.21 / $57,543.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $14,125.38 / $107,151.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,498.45 / $22,908.68 / $23,442.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,442.29 / $23,442.29 / $23,442.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $38,018.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,782.79 / $21,379.62 / $28,183.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $13,489.63 / $22,387.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,892.96 / $20,892.96 / $20,892.96