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South Dakota rates for HCPCS L5629

Addition To Lower Extremity Below Knee Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.48 / $319.48 / $319.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.70 / $319.48 / $372.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $419.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.13 / $442.13 / $552.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.06 / $490.71 / $2,003.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.96 / $286.70 / $452.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.88 / $419.57 / $731.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.63 / $425.49 / $801.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.16 / $372.49 / $442.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.00 / $253.73 / $327.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.80 / $373.80 / $373.80