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South Dakota rates for HCPCS L5632

Addition to lower extremity, Symes type, PTB brim design socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.25 / $272.25 / $272.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.88 / $272.25 / $319.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.52 / $166.52 / $332.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.88 / $376.88 / $471.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.54 / $343.95 / $1,389.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.52 / $210.87 / $345.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.43 / $332.44 / $511.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.26 / $337.13 / $635.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.27 / $319.93 / $380.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.10 / $177.27 / $272.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.18 / $296.18 / $296.18