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South Dakota rates for HCPCS L5618

Addition to lower extremity, test socket, Symes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.86 / $337.86 / $337.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.64 / $329.64 / $337.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.68 / $271.68 / $392.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.28 / $467.63 / $584.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.30 / $434.14 / $1,747.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.47 / $224.54 / $408.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.52 / $392.70 / $647.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.61 / $398.23 / $750.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.57 / $329.64 / $391.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.86 / $224.54 / $280.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.86 / $349.86 / $349.86