go back

South Dakota rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.24 / $387.24 / $387.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.62 / $338.61 / $387.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $381.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.99 / $535.88 / $669.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.00 / $445.90 / $1,951.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.13 / $260.63 / $451.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.13 / $381.41 / $665.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.37 / $386.78 / $728.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.22 / $338.61 / $402.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.13 / $230.64 / $485.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.81 / $339.81 / $339.81