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South Dakota rates for HCPCS L5280

Hemipelvectomy 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
$6,123.10 / $6,123.10 / $6,123.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,616.43 / $6,123.10 / $7,915.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,728.96 / $4,728.96 / $7,915.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,475.00 / $8,475.00 / $10,593.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,182.57 / $8,231.96 / $34,402.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,229.06 / $4,835.42 / $8,225.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,581.71 / $7,915.64 / $11,727.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,909.12 / $8,027.05 / $15,126.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.94 / $7,915.37 / $9,408.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,387.19 / $4,065.10 / $6,739.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,052.12 / $7,052.12 / $7,052.12