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South Dakota rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.06 / $500.06 / $500.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.06 / $621.29 / $777.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $380.63 / $875.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.25 / $699.17 / $865.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$543.97 / $1,111.64 / $3,301.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.12 / $496.41 / $862.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.07 / $875.63 / $1,145.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.32 / $887.94 / $1,673.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.98 / $777.37 / $924.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.84 / $529.50 / $708.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.11 / $780.11 / $780.11