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South Dakota rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.72 / $441.72 / $441.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.60 / $441.72 / $515.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $580.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.25 / $611.25 / $764.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.11 / $679.49 / $2,777.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.10 / $350.79 / $625.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.34 / $580.10 / $1,012.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.10 / $588.27 / $1,108.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.89 / $515.00 / $612.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.00 / $350.79 / $438.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.80 / $516.80 / $516.80