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South Dakota rates for HCPCS L5160

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,752.33 / $4,752.33 / $4,752.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,080.53 / $4,752.33 / $5,020.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,670.30 / $3,670.30 / $5,751.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,553.59 / $6,577.50 / $8,221.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,869.07 / $5,902.56 / $24,492.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,048.19 / $3,419.87 / $5,976.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,781.85 / $5,751.00 / $8,797.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,710.10 / $5,831.95 / $10,990.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,288.47 / $5,020.72 / $5,967.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.94 / $3,419.87 / $5,957.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,123.62 / $5,123.62 / $5,123.62