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South Dakota rates for HCPCS L5341

Hemipelvectomy, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,624.18 / $5,624.18 / $5,624.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,319.86 / $5,624.18 / $7,110.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,790.37 / $3,790.37 / $7,497.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,784.25 / $7,784.25 / $9,730.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,368.30 / $7,952.81 / $32,412.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,900.59 / $4,799.60 / $7,791.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,234.18 / $7,497.68 / $11,640.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,206.30 / $7,603.22 / $14,327.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,073.19 / $7,110.20 / $8,451.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,369.52 / $4,035.00 / $6,053.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,679.75 / $6,679.75 / $6,679.75