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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
$4,570.88 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $4,570.88 / $5,754.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $6,456.54 / $16,595.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,981.07 / $34,673.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $7,585.78 / $7,585.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $7,762.47 / $7,762.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $11,220.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,309.57 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,890.45 / $6,165.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83