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South Dakota rates for HCPCS L5981

All Lower Extremity Prostheses Flex-Walk System Or Equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.25 / $3,450.25 / $3,450.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.41 / $3,450.25 / $3,786.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,160.07 / $2,160.07 / $4,409.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,775.25 / $4,775.25 / $5,969.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,739.16 / $4,287.02 / $18,029.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,544.72 / $2,579.21 / $4,396.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,666.08 / $4,409.09 / $6,633.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,611.08 / $4,471.14 / $8,425.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,234.28 / $3,786.55 / $4,500.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.36 / $2,471.54 / $3,224.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,928.09 / $3,928.09 / $3,928.09