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South Dakota rates for HCPCS L5645

Addition to lower extremity, below knee (BK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.05 / $985.05 / $985.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.45 / $985.05 / $1,246.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.09 / $694.09 / $1,053.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,363.50 / $1,363.50 / $1,704.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.04 / $1,296.83 / $4,987.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.52 / $796.28 / $1,199.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.91 / $1,053.43 / $1,837.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.80 / $1,088.44 / $2,289.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,065.09 / $1,246.96 / $1,482.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.09 / $848.67 / $1,352.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.51 / $938.51 / $938.51