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South Dakota rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.85 / $1,130.85 / $1,130.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.68 / $1,130.85 / $1,162.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $1,335.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.85 / $1,565.25 / $1,956.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.71 / $1,326.50 / $5,705.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.38 / $792.06 / $1,388.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.56 / $1,335.64 / $2,099.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.88 / $1,354.43 / $2,552.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.23 / $1,162.83 / $1,382.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.28 / $727.61 / $990.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.94 / $1,189.94 / $1,189.94