go back

South Dakota rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,893.24 / $3,893.24 / $3,893.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.07 / $3,893.24 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $4,913.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,388.75 / $5,388.75 / $6,735.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,085.13 / $5,368.16 / $22,146.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,822.24 / $3,042.59 / $5,105.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,085.22 / $4,913.17 / $8,001.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,023.91 / $4,982.33 / $9,388.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,815.36 / $4,466.84 / $5,309.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,628.74 / $3,042.59 / $3,803.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,377.18 / $4,377.18 / $4,377.18