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South Dakota rates for HCPCS L5979

All lower extremity prostheses, multiaxial ankle, dynamic response foot, one-piece system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,521.09 / $2,521.09 / $2,521.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.09 / $2,849.99 / $3,237.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.28 / $1,711.28 / $4,016.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,489.38 / $3,524.27 / $4,361.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,495.38 / $3,898.94 / $14,301.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,320.70 / $2,166.92 / $3,552.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,339.82 / $4,016.71 / $5,255.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,143.76 / $4,073.24 / $7,675.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,765.24 / $3,237.42 / $3,848.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.79 / $2,277.15 / $3,461.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,578.52 / $3,578.52 / $3,578.52