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South Dakota rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,758.78 / $2,758.78 / $2,758.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,467.36 / $2,724.16 / $2,758.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,743.07 / $3,477.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,818.25 / $3,818.25 / $4,772.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,357.17 / $3,591.29 / $14,630.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.32 / $1,855.57 / $3,613.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,891.42 / $3,477.42 / $5,353.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,848.03 / $3,526.36 / $6,645.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.85 / $2,724.16 / $3,238.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,089.66 / $1,855.57 / $2,472.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,098.06 / $3,098.06 / $3,098.06