go back

South Dakota rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,834.40 / $1,834.40 / $1,834.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.96 / $1,834.40 / $2,162.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.54 / $1,222.54 / $2,397.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,539.13 / $2,564.52 / $3,173.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,629.13 / $3,100.14 / $10,198.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.09 / $1,472.82 / $2,491.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,993.31 / $2,397.29 / $3,754.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,963.40 / $2,431.04 / $4,581.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,846.90 / $2,162.23 / $2,570.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.26 / $1,470.66 / $2,190.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,135.76 / $2,135.76 / $2,135.76