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South Dakota rates for HCPCS L5634

Addition to lower extremity, Symes type, posterior opening (Canadian) socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.47 / $340.47 / $340.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.38 / $340.47 / $475.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.64 / $274.64 / $431.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.38 / $471.38 / $589.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.14 / $494.40 / $1,955.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $288.88 / $486.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.04 / $431.79 / $700.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.97 / $437.89 / $872.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.06 / $475.39 / $565.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.62 / $242.86 / $404.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.69 / $384.69 / $384.69