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South Dakota rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Facilitymedian $200 · 10th–90th $186–$3630%20%40%10th90th$200Professionalmedian $200 · 10th–90th $115–$3090%10%20%10th90th$200$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $199.53 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $338.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $223.87 / $588.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $169.82 / $1,479.11
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $257.04 / $263.03
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $398.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $223.87 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $169.82 / $275.42
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42