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South Dakota rates for HCPCS L5656

Addition To Lower Extremity Socket Insert Knee Disarticulation (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.84 / $434.84 / $434.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.76 / $434.84 / $448.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $554.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.88 / $601.88 / $752.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.77 / $572.50 / $2,344.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.04 / $305.62 / $576.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.43 / $554.94 / $854.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.51 / $562.76 / $1,060.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.24 / $448.67 / $533.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.92 / $296.16 / $394.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.40 / $494.40 / $494.40