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South Dakota rates for HCPCS L5666

Addition to lower extremity, below knee (BK), cuff suspension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.52 / $77.52 / $77.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.91 / $77.52 / $82.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.87 / $59.87 / $98.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.10 / $107.25 / $134.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.00 / $108.67 / $445.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.47 / $55.89 / $102.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.93 / $98.54 / $161.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.70 / $99.92 / $188.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.08 / $82.04 / $97.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.82 / $55.89 / $74.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.79 / $87.79 / $87.79