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South Dakota rates for HCPCS L5639

Addition To Lower Extremity Below Knee Wood Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.14 / $1,127.14 / $1,127.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.29 / $1,127.14 / $1,752.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $1,480.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.00 / $1,560.00 / $1,950.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.70 / $1,822.28 / $7,424.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.72 / $1,064.76 / $1,712.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.80 / $1,480.25 / $2,582.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.26 / $1,529.45 / $3,216.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.65 / $1,752.19 / $2,082.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.66 / $895.13 / $1,491.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.77 / $1,318.77 / $1,318.77