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South Dakota rates for HCPCS L5702

Replacement Socket Hip Disarticulation Including Hip Joint Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,849.53 / $4,849.53 / $4,849.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,849.53 / $5,407.79 / $6,118.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $3,745.37 / $7,621.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,712.13 / $7,621.60 / $8,390.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,734.95 / $7,398.09 / $27,462.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,496.06 / $4,125.99 / $6,832.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,337.23 / $7,621.60 / $10,007.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,965.23 / $7,728.88 / $14,564.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,226.18 / $6,118.56 / $7,272.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,036.96 / $3,125.74 / $4,992.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,790.16 / $6,790.16 / $6,790.16