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South Dakota rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.75 / $565.75 / $565.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.04 / $565.75 / $664.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $436.96 / $738.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.00 / $783.00 / $978.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.42 / $804.41 / $3,169.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.20 / $452.82 / $767.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.11 / $738.58 / $1,165.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.90 / $748.97 / $1,411.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.83 / $664.80 / $790.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.21 / $452.82 / $720.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.01 / $658.01 / $658.01