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South Dakota rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.76 / $686.76 / $686.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.73 / $686.76 / $968.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $838.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.63 / $960.13 / $1,188.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.49 / $1,007.00 / $3,873.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.47 / $588.38 / $952.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.94 / $838.20 / $1,427.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.91 / $849.98 / $1,777.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.04 / $968.27 / $1,150.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.48 / $558.96 / $1,082.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.76 / $746.76 / $746.76