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South Dakota rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,041.74 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,445.44 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,467.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,454.71 / $6,606.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,412.54 / $12,302.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,041.74 / $2,041.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $4,466.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,511.89 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,412.54 / $2,454.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70