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South Dakota rates for HCPCS L5420

Immediate Post Surgical Or Early Fitting Application Of Initial Rigid Dressing Including Fitting Alignment And Suspension And One Cast Change Ak Or Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,037.47 / $2,037.47 / $2,037.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.38 / $2,003.72 / $2,037.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,573.58 / $1,573.58 / $2,407.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,615.46 / $2,820.00 / $3,525.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.98 / $2,348.81 / $9,671.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.42 / $1,364.83 / $2,502.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,001.99 / $2,407.75 / $3,501.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,971.97 / $2,441.64 / $4,601.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.49 / $2,003.72 / $2,381.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.65 / $1,213.56 / $1,706.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,145.08 / $2,145.08 / $2,145.08