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South Dakota rates for HCPCS L6200

Elbow disarticulation, molded socket, outside locking hinge, forearm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,307.59 / $3,307.59 / $3,307.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,059.85 / $3,307.59 / $3,574.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,694.60 / $2,694.60 / $4,312.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,578.00 / $4,623.78 / $5,722.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,829.14 / $4,186.05 / $17,419.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.03 / $2,434.46 / $4,481.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.75 / $4,312.47 / $6,283.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,531.94 / $4,373.17 / $8,241.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,052.78 / $3,574.06 / $4,248.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.04 / $2,178.06 / $3,043.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,842.03 / $3,842.03 / $3,842.03