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South Dakota rates for HCPCS L5978

All lower extremity prostheses, foot, multiaxial ankle/foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.87 / $314.87 / $314.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.87 / $342.05 / $364.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.19 / $243.19 / $513.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.75 / $440.11 / $544.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.14 / $455.98 / $1,857.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.54 / $232.99 / $469.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.15 / $513.72 / $672.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.08 / $520.95 / $981.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.17 / $342.05 / $406.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.54 / $232.99 / $413.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.68 / $457.68 / $457.68