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South Dakota rates for HCPCS L5636

Addition To Lower Extremity Symes Type Medial Opening Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.24 / $260.24 / $260.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.62 / $260.24 / $398.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.02 / $197.02 / $340.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.38 / $360.38 / $450.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.29 / $414.14 / $1,592.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.81 / $241.98 / $386.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.16 / $340.54 / $586.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.33 / $347.58 / $731.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.13 / $398.20 / $473.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.46 / $203.43 / $339.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.39 / $303.39 / $303.39