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South Dakota rates for HCPCS L5988

Addition to lower limb prosthesis, vertical shock reducing pylon feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,019.99 / $2,019.99 / $2,019.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,873.01 / $2,019.99 / $2,380.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $1,346.19 / $2,639.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,796.00 / $2,796.00 / $3,495.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,793.92 / $3,413.78 / $11,271.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.28 / $1,621.74 / $2,743.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,194.92 / $2,639.78 / $4,134.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,161.98 / $2,676.93 / $5,044.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,033.65 / $2,380.88 / $2,830.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.56 / $1,619.40 / $2,411.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,351.80 / $2,351.80 / $2,351.80