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South Dakota rates for HCPCS L5270

Hip Disarticulation Tilt Table Type; Molded Socket Locking Hip Joint Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,299.24 / $6,299.24 / $6,299.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,722.23 / $6,299.24 / $6,968.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,865.01 / $4,865.01 / $8,064.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,718.75 / $8,718.75 / $10,898.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,010.25 / $7,947.21 / $33,007.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,842.69 / $4,746.43 / $8,380.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,705.71 / $8,064.76 / $11,846.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,605.09 / $8,178.27 / $15,411.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,951.96 / $6,968.26 / $8,282.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,411.31 / $4,106.16 / $5,933.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,184.97 / $7,184.97 / $7,184.97