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South Dakota rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.78 / $468.78 / $468.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.64 / $468.78 / $552.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $612.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.75 / $648.75 / $810.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.33 / $792.24 / $2,615.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.41 / $376.36 / $636.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$509.34 / $612.57 / $959.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.71 / $621.19 / $1,170.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.95 / $552.53 / $656.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.30 / $360.65 / $593.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.74 / $545.74 / $545.74