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South Dakota rates for HCPCS L5987

All lower extremity prostheses, shank foot system with vertical loading pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,274.04 / $7,274.04 / $7,274.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,744.80 / $7,274.04 / $8,573.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $6,042.00 / $9,505.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,068.00 / $10,068.00 / $12,585.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,459.91 / $12,293.13 / $40,507.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,497.68 / $5,840.06 / $9,478.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,904.02 / $9,505.94 / $14,887.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,785.41 / $9,639.74 / $18,165.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,323.36 / $8,573.83 / $10,191.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,030.47 / $5,840.06 / $9,207.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,468.92 / $8,468.92 / $8,468.92