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South Dakota rates for HCPCS L5331

Hip Disarticulation Canadian Type Molded Socket Endoskeletal System Hip Joint Single Axis Knee Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,290.92 / $5,290.92 / $5,290.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,204.66 / $5,290.92 / $6,566.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,052.23 / $4,052.23 / $7,335.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,323.00 / $7,335.32 / $9,153.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,144.22 / $7,443.60 / $29,802.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,678.80 / $4,416.75 / $7,622.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,099.17 / $7,335.32 / $10,712.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,007.64 / $7,438.54 / $14,017.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,608.82 / $6,566.51 / $7,805.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,180.50 / $3,354.59 / $5,590.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,535.10 / $6,535.10 / $6,535.10