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South Dakota rates for HCPCS L5686

Addition To Lower Extremity Below Knee Back Check (Extension Control)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.19 / $58.19 / $58.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.59 / $58.19 / $70.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $72.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.63 / $80.63 / $100.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.98 / $78.43 / $328.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.86 / $48.18 / $75.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.46 / $72.72 / $117.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.75 / $73.73 / $138.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.43 / $70.73 / $84.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $46.18 / $60.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.79 / $64.79 / $64.79