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South Dakota rates for HCPCS L5644

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.78 / $593.78 / $593.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.78 / $604.82 / $923.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.59 / $458.59 / $852.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.00 / $830.22 / $1,027.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$592.97 / $959.99 / $3,692.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.44 / $560.91 / $885.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.77 / $852.42 / $1,360.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.80 / $864.42 / $1,694.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.45 / $923.06 / $1,097.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.92 / $628.23 / $815.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.43 / $759.43 / $759.43