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South Dakota rates for HCPCS L5986

All lower extremity prostheses, multiaxial rotation unit (MCP or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.28 / $784.28 / $784.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.20 / $784.28 / $990.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.31 / $663.31 / $943.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.63 / $1,085.63 / $1,357.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.10 / $1,029.94 / $4,017.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.49 / $632.40 / $1,003.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.21 / $943.16 / $1,459.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.95 / $956.42 / $1,818.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.90 / $990.33 / $1,177.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.03 / $646.41 / $1,076.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.27 / $840.27 / $840.27