go back

South Dakota rates for HCPCS L5697

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

Facilitymedian $93 · 10th–90th $76–$1740%20%40%10th90th$93Professionalmedian $93 · 10th–90th $42–$1380%10%20%10th90th$93$50.0$100.0$200.0$500.0

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
$75.86 / $93.33 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $93.33 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $281.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $74.13 / $645.65
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $107.15
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $186.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $104.71 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $74.13 / $131.83
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50