go back

South Dakota rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.12 / $1,491.12 / $1,491.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,491.12 / $1,576.05 / $1,983.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $2,221.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,064.00 / $2,084.64 / $2,580.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,379.95 / $2,156.14 / $8,261.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.00 / $1,219.69 / $2,193.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,846.92 / $2,221.23 / $2,958.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,769.52 / $2,252.50 / $4,244.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,693.85 / $1,983.08 / $2,357.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.87 / $1,366.05 / $2,047.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.92 / $1,978.92 / $1,978.92