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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
$1,479.11 / $1,479.11 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,288.25 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $5,495.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $10,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $2,238.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $3,630.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,041.74 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,148.15 / $1,819.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26