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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
$115.47 / $115.47 / $115.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.74 / $115.47 / $118.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $89.19 / $134.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.50 / $159.75 / $199.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.43 / $155.16 / $645.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.29 / $80.62 / $143.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $134.93 / $232.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.52 / $136.84 / $257.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.09 / $118.36 / $140.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.34 / $80.62 / $107.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.21 / $120.21 / $120.21