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South Dakota rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.99 / $458.99 / $458.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.10 / $458.99 / $488.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $577.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.25 / $635.25 / $794.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.06 / $562.41 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.28 / $332.74 / $587.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.58 / $577.97 / $837.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.36 / $586.11 / $1,104.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.25 / $488.49 / $580.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.47 / $328.04 / $723.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.91 / $514.91 / $514.91