go back

South Dakota rates for HCPCS L5966

Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,460.14 / $1,460.14 / $1,460.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,396.97 / $1,460.14 / $1,577.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.00 / $895.00 / $1,968.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,020.88 / $2,020.88 / $2,526.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.17 / $1,911.14 / $7,595.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.46 / $1,074.38 / $2,033.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,637.06 / $1,968.85 / $2,748.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,612.51 / $1,996.57 / $3,762.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.24 / $1,577.30 / $1,874.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.50 / $1,029.53 / $1,699.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,754.06 / $1,754.06 / $1,754.06