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South Dakota rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $87.10 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $199.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $131.83 / $323.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $81.28 / $794.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $134.90 / $134.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $218.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $120.23 / $162.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $81.28 / $144.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23