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South Dakota rates for HCPCS L5050

Ankle, Symes, molded socket, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,770.64 / $2,770.64 / $2,770.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,167.19 / $2,770.64 / $2,918.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,084.13 / $2,084.13 / $3,054.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,809.01 / $3,834.75 / $4,793.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.98 / $3,545.91 / $14,469.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.44 / $1,987.66 / $3,269.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,539.67 / $3,054.39 / $5,285.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.14 / $3,097.37 / $5,836.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,492.51 / $2,918.11 / $3,468.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.98 / $1,904.70 / $2,484.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.19 / $2,721.19 / $2,721.19