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South Dakota rates for HCPCS L5651

Addition to lower extremity, above knee (AK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,437.93 / $1,437.93 / $1,437.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.99 / $1,437.93 / $1,876.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.11 / $1,200.11 / $1,585.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.13 / $1,990.13 / $2,487.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.46 / $1,951.88 / $7,578.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.93 / $1,198.49 / $1,801.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.34 / $1,585.53 / $2,766.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.57 / $1,638.22 / $3,445.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,603.09 / $1,876.81 / $2,230.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.04 / $1,083.46 / $1,597.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.56 / $1,412.56 / $1,412.56