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South Dakota rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,214.82 / $3,214.82 / $3,214.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,856.51 / $3,214.82 / $3,532.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $4,025.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,449.75 / $4,449.75 / $5,562.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,056.58 / $4,262.38 / $17,674.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.06 / $2,406.14 / $4,183.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,347.45 / $4,025.89 / $6,353.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,297.23 / $4,082.55 / $7,693.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,017.26 / $3,532.47 / $4,198.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.19 / $2,305.69 / $3,007.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,586.70 / $3,586.70 / $3,586.70