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South Dakota rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $120.23 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $204.17 / $446.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $120.23 / $1,174.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $208.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $295.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $165.96 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $109.65 / $169.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21