go back

South Dakota rates for HCPCS L5400

Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,613.25 / $1,613.25 / $1,613.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,268.04 / $1,438.46 / $1,613.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$902.63 / $902.63 / $1,787.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,877.63 / $2,232.75 / $2,790.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,244.67 / $1,859.78 / $7,563.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.82 / $979.81 / $1,857.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,485.98 / $1,787.15 / $2,772.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,463.69 / $1,812.30 / $3,415.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,228.67 / $1,438.46 / $1,709.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.82 / $1,142.97 / $2,214.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,592.19 / $1,592.19 / $1,592.19