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South Dakota rates for HCPCS L5980

All Lower Extremity Prostheses Flex Foot System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,841.11 / $3,841.11 / $3,841.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,841.11 / $3,865.63 / $5,794.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,780.72 / $2,780.72 / $5,448.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,316.38 / $5,369.54 / $6,645.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,482.82 / $6,026.22 / $23,421.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,284.56 / $3,521.11 / $5,933.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,530.00 / $5,448.11 / $8,539.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,932.85 / $5,524.79 / $10,637.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,949.35 / $5,794.46 / $6,887.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.34 / $2,960.17 / $4,933.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,853.77 / $4,853.77 / $4,853.77