go back

South Dakota rates for HCPCS L5653

Addition to lower extremity, knee disarticulation, expandable wall socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$683.87 / $683.87 / $683.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.11 / $683.87 / $909.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.76 / $555.76 / $889.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.50 / $946.50 / $1,183.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.60 / $945.93 / $3,703.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.05 / $552.71 / $914.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.59 / $889.47 / $1,340.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.93 / $901.99 / $1,699.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.90 / $909.56 / $1,081.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.87 / $464.66 / $774.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.44 / $792.44 / $792.44