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South Dakota rates for HCPCS L5638

Addition to lower extremity, below knee (BK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.33 / $652.33 / $652.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.89 / $652.33 / $760.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.81 / $503.81 / $642.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.00 / $912.03 / $1,128.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.27 / $790.99 / $3,083.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.27 / $462.17 / $757.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.25 / $642.52 / $1,120.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.76 / $663.88 / $1,396.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.64 / $760.56 / $904.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.17 / $388.54 / $647.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.42 / $572.42 / $572.42