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South Dakota rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.47 / $585.47 / $585.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.47 / $600.15 / $632.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.18 / $452.18 / $890.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.38 / $810.38 / $1,012.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.40 / $791.53 / $3,241.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.83 / $408.79 / $815.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.69 / $890.80 / $1,179.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.45 / $903.34 / $1,702.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.62 / $600.15 / $713.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.06 / $408.79 / $544.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.62 / $793.62 / $793.62