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South Dakota rates for HCPCS L5940

Addition, endoskeletal system, below knee (BK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.28 / $504.28 / $504.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.28 / $623.22 / $783.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $878.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.88 / $704.85 / $872.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.66 / $852.23 / $3,201.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.80 / $500.60 / $799.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.32 / $878.34 / $1,155.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.11 / $890.71 / $1,678.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.59 / $783.92 / $931.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.18 / $452.54 / $667.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.52 / $782.52 / $782.52