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South Dakota rates for HCPCS L5652

Addition To Lower Extremity Suction Suspension Above Knee Or Knee Disarticulation Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.30 / $438.30 / $438.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.42 / $438.30 / $681.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.50 / $338.50 / $575.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.75 / $606.75 / $758.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.71 / $708.61 / $2,725.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.37 / $435.10 / $653.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.61 / $575.61 / $1,004.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.17 / $594.74 / $1,250.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.98 / $681.36 / $809.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.41 / $348.08 / $580.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.80 / $512.80 / $512.80