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South Dakota rates for HCPCS L5540

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,071.67 / $2,071.67 / $2,071.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,071.67 / $2,114.98 / $2,380.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,599.98 / $1,599.98 / $2,980.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,867.25 / $2,895.92 / $3,584.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,890.48 / $2,893.32 / $11,580.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.30 / $1,621.77 / $3,090.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,478.48 / $2,980.79 / $4,168.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,441.27 / $3,022.74 / $5,696.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,033.68 / $2,380.92 / $2,830.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.59 / $1,445.04 / $2,027.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,655.61 / $2,655.61 / $2,655.61