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South Dakota rates for HCPCS L5705

Custom Shaped Protective Cover Above Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,159.42 / $1,159.42 / $1,159.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.15 / $1,159.42 / $1,178.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $895.43 / $1,347.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.31 / $1,604.63 / $2,005.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.48 / $1,362.34 / $5,814.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.77 / $802.74 / $1,400.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.48 / $1,347.58 / $2,139.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.66 / $1,366.53 / $2,575.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.61 / $1,178.50 / $1,400.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.52 / $802.74 / $1,384.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.57 / $1,200.57 / $1,200.57