go back

South Dakota rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,674.44 / $3,674.44 / $3,674.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,407.14 / $3,674.44 / $4,331.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $4,801.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,085.75 / $5,085.75 / $6,357.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,263.20 / $6,209.80 / $20,504.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,766.85 / $2,950.10 / $4,990.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,992.71 / $4,801.93 / $7,520.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,932.78 / $4,869.51 / $9,176.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,699.39 / $4,331.07 / $5,148.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,530.84 / $2,826.96 / $4,386.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,278.08 / $4,278.08 / $4,278.08