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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
$446.68 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $446.68 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $457.09 / $4,265.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $891.25 / $891.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,096.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $616.60 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $407.38 / $724.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33