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South Dakota rates for HCPCS L5925

Addition Endoskeletal System Above Knee Knee Disarticulation Or Hip Disarticulation Manual Lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.80 / $337.80 / $337.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.80 / $416.54 / $525.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.88 / $260.88 / $587.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.63 / $472.30 / $584.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.69 / $569.90 / $2,277.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.22 / $335.33 / $585.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.13 / $587.07 / $773.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.94 / $595.30 / $1,121.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.53 / $525.12 / $624.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.54 / $268.26 / $447.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.03 / $523.03 / $523.03