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South Dakota rates for HCPCS L5210

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Foot Blocks No Ankle Joints Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,918.41 / $2,918.41 / $2,918.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,440.09 / $2,918.41 / $3,065.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $3,439.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,001.67 / $4,039.50 / $5,049.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,485.44 / $3,749.81 / $15,534.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,250.65 / $2,088.19 / $3,573.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,859.46 / $3,439.00 / $5,589.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,816.54 / $3,487.40 / $6,571.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,618.58 / $3,065.70 / $3,644.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.69 / $2,088.19 / $4,006.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,063.83 / $3,063.83 / $3,063.83