go back

South Dakota rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $4,677.35 / $4,677.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,548.13 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $7,943.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $5,128.61 / $12,882.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,235.94 / $44,668.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,248.07 / $5,370.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $8,709.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $4,786.30 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,235.94 / $5,754.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $4,786.30