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South Dakota rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,709.06 / $2,709.06 / $2,709.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,437.12 / $2,709.06 / $2,713.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $3,434.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,541.78 / $3,749.63 / $4,687.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,347.83 / $3,567.19 / $14,785.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.92 / $2,071.46 / $3,424.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,855.99 / $3,434.81 / $5,288.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,813.14 / $3,483.16 / $6,563.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,317.63 / $2,713.38 / $3,225.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.48 / $1,833.11 / $2,310.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.10 / $3,060.10 / $3,060.10