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South Dakota rates for HCPCS L5688

Addition to lower extremity, below knee (BK), waist belt, webbing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.81 / $61.81 / $61.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.81 / $66.45 / $71.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.81 / $45.81 / $93.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.50 / $86.36 / $106.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.72 / $95.23 / $392.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $48.77 / $97.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.88 / $93.68 / $140.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.72 / $94.98 / $178.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.15 / $71.59 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.64 / $48.77 / $73.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.46 / $83.46 / $83.46