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South Dakota rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,328.35 / $4,328.35 / $4,328.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,839.99 / $4,328.35 / $4,559.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,249.00 / $3,249.00 / $5,411.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,950.97 / $5,990.63 / $7,488.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,677.41 / $5,425.86 / $22,345.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,859.87 / $3,105.41 / $5,624.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,499.97 / $5,411.99 / $8,088.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,432.43 / $5,488.17 / $10,342.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,894.14 / $4,559.07 / $5,419.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,646.44 / $3,105.41 / $5,002.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,821.59 / $4,821.59 / $4,821.59