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South Dakota rates for HCPCS L5630

Addition To Lower Extremity Symes Type Expandable Wall Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.12 / $555.12 / $555.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.02 / $555.12 / $574.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.88 / $393.88 / $761.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.38 / $768.38 / $960.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.83 / $723.30 / $2,807.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.36 / $391.30 / $759.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.83 / $761.09 / $1,033.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.34 / $771.81 / $1,454.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.69 / $574.48 / $682.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.95 / $391.30 / $695.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.06 / $678.06 / $678.06