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South Dakota rates for HCPCS L5795

Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,079.40 / $1,079.40 / $1,079.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.80 / $1,079.40 / $1,258.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $908.11 / $1,417.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.00 / $1,508.94 / $1,867.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.93 / $1,432.92 / $6,807.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.40 / $857.22 / $1,529.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.67 / $1,417.56 / $2,473.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.99 / $1,437.51 / $2,708.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.94 / $1,258.48 / $1,495.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.39 / $857.22 / $1,105.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.92 / $1,262.92 / $1,262.92