go back

South Dakota rates for HCPCS L5510

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,780.64 / $1,780.64 / $1,780.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,618.76 / $1,780.64 / $1,975.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.24 / $1,375.24 / $2,281.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,464.50 / $2,464.50 / $3,080.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,515.12 / $2,300.07 / $9,328.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.05 / $1,345.86 / $2,370.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,896.97 / $2,281.44 / $3,353.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,868.50 / $2,313.54 / $4,359.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,687.69 / $1,975.86 / $2,348.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.58 / $1,162.33 / $1,682.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,032.56 / $2,032.56 / $2,032.56