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South Dakota rates for HCPCS L5661

Addition To Lower Extremity Socket Insert Multi-Durometer Symes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.55 / $658.55 / $658.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.48 / $658.55 / $713.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.40 / $456.40 / $901.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.63 / $911.63 / $1,139.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.91 / $939.97 / $3,730.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.98 / $485.86 / $936.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.39 / $901.26 / $1,401.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.13 / $913.95 / $1,722.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.25 / $713.29 / $847.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.32 / $485.86 / $607.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.94 / $802.94 / $802.94