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South Dakota rates for HCPCS L5974

All lower extremity prostheses, foot, single axis ankle/foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.27 / $234.27 / $234.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.27 / $237.75 / $276.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.77 / $174.77 / $335.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.38 / $327.62 / $405.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.95 / $359.08 / $1,528.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.99 / $188.65 / $348.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.61 / $335.08 / $536.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.43 / $339.79 / $640.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.57 / $276.95 / $329.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.26 / $186.05 / $247.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.52 / $298.52 / $298.52