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South Dakota rates for HCPCS L5648

Addition to lower extremity, above knee (AK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$737.61 / $737.61 / $737.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.88 / $737.61 / $1,028.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.44 / $589.44 / $951.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.75 / $1,020.75 / $1,275.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.96 / $1,070.06 / $4,115.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.85 / $625.24 / $987.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.87 / $951.16 / $1,516.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.20 / $964.54 / $1,888.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.85 / $1,028.92 / $1,223.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $525.64 / $876.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.40 / $847.40 / $847.40