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South Dakota rates for HCPCS L6050

Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,513.48 / $2,513.48 / $2,513.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,133.94 / $2,396.13 / $2,513.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.68 / $1,424.68 / $3,007.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,478.88 / $3,478.88 / $4,348.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,043.58 / $2,919.28 / $12,107.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.50 / $1,632.12 / $3,125.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,500.69 / $3,007.51 / $4,375.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.17 / $3,049.84 / $5,747.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,046.66 / $2,396.13 / $2,848.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.62 / $1,516.62 / $2,040.15
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,679.42 / $2,679.42 / $2,679.42