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South Dakota rates for HCPCS L5707

Custom Shaped Protective Cover Hip Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,519.35 / $1,519.35 / $1,519.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.13 / $1,519.35 / $1,604.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.20 / $1,232.20 / $1,898.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,094.16 / $2,103.00 / $2,628.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.49 / $1,842.91 / $7,733.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.49 / $1,092.80 / $1,973.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,578.65 / $1,898.60 / $2,849.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.95 / $1,925.32 / $3,628.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.36 / $1,604.35 / $1,907.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.98 / $987.64 / $1,366.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.48 / $1,691.48 / $1,691.48