go back

South Dakota rates for HCPCS L6130

Below elbow, molded double wall split socket, stump activated locking hinge, half cuff

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,235.94 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,454.71 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $5,495.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,467.37 / $9,120.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,290.87 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,890.45 / $3,890.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $6,025.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,388.44 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,238.72 / $3,890.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37