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South Dakota rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,653.62 / $5,653.62 / $5,653.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,462.69 / $5,653.62 / $7,639.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $4,366.38 / $7,698.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,825.13 / $7,825.13 / $9,781.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,010.43 / $8,017.24 / $33,390.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,116.36 / $4,927.43 / $8,000.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,401.56 / $7,698.98 / $11,950.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,667.96 / $7,807.35 / $14,712.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,524.95 / $7,639.11 / $9,080.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,589.04 / $5,203.38 / $7,762.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,859.09 / $6,859.09 / $6,859.09