go back

South Dakota rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,025.61 / $2,025.61 / $2,025.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.03 / $2,025.61 / $2,432.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $2,054.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,803.50 / $2,803.50 / $3,504.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.64 / $2,529.71 / $9,793.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.44 / $1,478.11 / $2,482.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,708.63 / $2,054.91 / $3,584.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,860.56 / $2,123.19 / $4,465.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,077.66 / $2,432.42 / $2,891.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.73 / $1,242.64 / $2,071.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,830.74 / $1,830.74 / $1,830.74