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South Dakota rates for HCPCS L5961

Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,826.54 / $4,826.54 / $4,826.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,572.45 / $4,826.54 / $6,009.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.42 / $3,728.42 / $6,444.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,680.25 / $6,680.25 / $8,350.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,213.57 / $10,156.78 / $26,807.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,451.73 / $4,064.11 / $6,696.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,358.31 / $6,444.30 / $9,856.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,358.31 / $6,534.99 / $12,314.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $6,009.93 / $7,143.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.41 / $3,416.67 / $5,117.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,741.28 / $5,741.28 / $5,741.28