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South Dakota rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,101.56 / $3,101.56 / $3,101.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,039.73 / $3,156.98 / $3,326.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $4,449.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,293.00 / $4,335.93 / $5,366.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,764.16 / $4,187.64 / $17,077.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.84 / $2,265.51 / $4,320.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,699.55 / $4,449.35 / $6,307.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,644.04 / $4,511.97 / $8,502.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,840.92 / $3,326.01 / $3,953.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,283.95 / $2,186.41 / $2,831.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,963.97 / $3,963.97 / $3,963.97