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South Dakota rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.14 / $1,596.14 / $1,596.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,596.14 / $1,644.23 / $1,685.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $2,317.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,209.13 / $2,209.13 / $2,761.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,458.49 / $2,222.21 / $9,329.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.62 / $1,148.11 / $2,380.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,926.83 / $2,317.33 / $3,312.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,897.91 / $2,349.96 / $4,428.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,439.72 / $1,685.55 / $2,003.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.22 / $1,148.11 / $1,435.15
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,064.53 / $2,064.53 / $2,064.53