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South Dakota rates for HCPCS L5985

All Endoskeletal Lower Extremity Protheses Dynamic Prosthetic Pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.54 / $285.54 / $285.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.50 / $285.54 / $335.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.51 / $220.51 / $372.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.25 / $395.25 / $494.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.57 / $361.85 / $1,599.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.86 / $228.50 / $387.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.95 / $372.78 / $588.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.30 / $378.03 / $712.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.55 / $335.47 / $398.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.72 / $203.86 / $285.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.11 / $332.11 / $332.11