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South Dakota rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $416.87 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $645.65 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $380.19 / $3,388.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $645.65 / $645.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $1,023.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $575.44 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $380.19 / $776.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44