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South Dakota rates for HCPCS L5230

Above Knee For Proximal Femoral Focal Deficiency Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,821.74 / $4,821.74 / $4,821.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,802.86 / $4,821.74 / $5,945.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $5,359.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,673.50 / $6,673.50 / $8,341.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,701.00 / $6,183.01 / $24,371.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,293.37 / $3,612.72 / $6,081.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,456.45 / $5,359.65 / $8,762.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,852.76 / $5,435.09 / $10,914.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,078.12 / $5,945.21 / $7,066.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.56 / $3,432.08 / $5,419.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,774.96 / $4,774.96 / $4,774.96