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South Dakota rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.78 / $490.78 / $490.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.32 / $490.78 / $762.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $644.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.13 / $685.92 / $848.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.12 / $793.46 / $3,128.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $487.20 / $731.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.91 / $644.53 / $1,124.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.57 / $665.95 / $1,400.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.66 / $762.94 / $906.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.88 / $389.76 / $649.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.22 / $574.22 / $574.22