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South Dakota rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.44 / $396.44 / $396.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.08 / $390.81 / $396.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $468.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.13 / $548.63 / $685.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.17 / $512.55 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.43 / $266.20 / $486.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.16 / $468.03 / $763.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.29 / $474.61 / $894.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.81 / $390.81 / $464.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.49 / $264.77 / $352.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.97 / $416.97 / $416.97