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South Dakota rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.75 / $299.75 / $299.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.13 / $299.75 / $325.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $209.59 / $373.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.75 / $414.75 / $518.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.95 / $429.09 / $1,729.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.94 / $250.82 / $396.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.70 / $373.67 / $640.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.05 / $378.94 / $714.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.33 / $325.86 / $387.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.34 / $221.96 / $396.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.91 / $332.91 / $332.91