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South Dakota rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $630.96 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,288.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,000.00 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $588.84 / $5,128.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $891.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,819.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,023.29 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $575.44 / $912.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33