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South Dakota rates for HCPCS L6205

Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,562.76 / $4,562.76 / $4,562.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,504.29 / $4,377.39 / $4,562.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,523.90 / $3,523.90 / $4,938.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,713.83 / $6,315.38 / $7,894.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,233.98 / $5,311.03 / $23,227.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.75 / $2,981.66 / $5,187.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,106.55 / $4,938.85 / $8,387.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,044.94 / $5,008.35 / $9,438.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,738.96 / $4,377.39 / $5,203.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.33 / $2,907.36 / $5,447.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,400.06 / $4,400.06 / $4,400.06