go back

South Dakota rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.20 / $206.20 / $206.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.67 / $206.20 / $218.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $246.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.38 / $285.38 / $356.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.59 / $289.05 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.16 / $148.86 / $265.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.69 / $246.17 / $429.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.61 / $249.63 / $470.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.67 / $218.54 / $259.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.42 / $168.22 / $246.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.31 / $219.31 / $219.31