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South Dakota rates for HCPCS L5962

Addition, endoskeletal system, below knee (BK), flexible protective outer surface covering system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $588.84 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $831.76 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $912.01 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $562.34 / $4,677.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,023.29 / $1,023.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $891.25 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $524.81 / $758.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01