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South Dakota rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.41 / $533.41 / $533.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.05 / $533.41 / $823.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $397.94 / $700.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.38 / $738.38 / $922.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.69 / $856.46 / $3,385.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.75 / $529.52 / $795.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.47 / $700.52 / $1,222.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.28 / $718.84 / $1,511.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.42 / $823.51 / $978.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.77 / $546.19 / $732.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.10 / $624.10 / $624.10