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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
$740.87 / $740.87 / $740.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.37 / $740.87 / $999.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.20 / $572.20 / $882.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.25 / $1,025.25 / $1,281.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.87 / $1,039.28 / $4,009.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.18 / $607.25 / $1,018.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.03 / $882.79 / $1,472.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.31 / $895.23 / $1,834.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.57 / $999.32 / $1,187.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.80 / $510.52 / $850.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.49 / $786.49 / $786.49