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South Dakota rates for HCPCS L5682

Addition to lower extremity, below knee (BK), thigh lacer, gluteal/ischial, molded

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $549.54 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $512.86 / $5,011.87
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 / $1,348.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $501.19 / $812.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33