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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
$590.91 / $590.91 / $590.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.91 / $734.17 / $877.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.56 / $448.56 / $1,034.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.88 / $826.05 / $1,022.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.83 / $998.65 / $3,726.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.05 / $558.21 / $950.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.35 / $1,034.72 / $1,353.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.84 / $1,049.29 / $1,977.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.67 / $877.68 / $1,043.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.58 / $469.28 / $747.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.84 / $921.84 / $921.84