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South Dakota rates for HCPCS L5960

Addition Endoskeletal System Hip Disarticulation Ultra-Light Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.51 / $1,169.51 / $1,169.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.39 / $1,129.96 / $1,169.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.44 / $930.44 / $1,411.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.95 / $1,618.88 / $2,023.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.73 / $1,369.90 / $6,077.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.97 / $769.67 / $1,466.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,173.50 / $1,411.33 / $2,220.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.89 / $1,431.19 / $2,697.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.16 / $1,129.96 / $1,343.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.98 / $769.67 / $962.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.36 / $1,257.36 / $1,257.36