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South Dakota rates for HCPCS L5972

All lower extremity prostheses, foot, flexible keel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.10 / $400.10 / $400.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.42 / $400.10 / $516.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.77 / $293.77 / $515.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.88 / $553.88 / $692.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.52 / $537.77 / $2,270.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.51 / $334.69 / $535.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.23 / $515.02 / $811.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.43 / $522.28 / $984.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.76 / $516.02 / $613.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.24 / $281.38 / $439.36
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.84 / $458.84 / $458.84