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South Dakota rates for HCPCS L6026

Transcarpal/Metacarpal Or Partial Hand Disarticu- Lation Prosthesis External Power Self-Suspended Inner Socket With Removable Forearm Section Electrodes And Cables Two Batteries Charger Myoelectric Control Of Terminal Device Excludes Terminal Device(S)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,398.42 / $4,398.42 / $4,398.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,398.42 / $4,410.05 / $5,582.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $3,323.97 / $6,215.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,087.75 / $6,148.63 / $7,609.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,039.83 / $9,435.04 / $25,033.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,277.52 / $3,644.02 / $6,459.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,167.99 / $6,215.41 / $8,635.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,627.56 / $6,302.87 / $13,046.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,768.62 / $5,582.87 / $6,636.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.79 / $3,802.77 / $5,776.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,537.36 / $5,537.36 / $5,537.36