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South Dakota rates for HCPCS L6300

Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,488.29 / $4,488.29 / $4,488.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,929.91 / $4,488.29 / $4,666.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,813.78 / $3,813.78 / $5,538.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,090.64 / $6,212.25 / $7,765.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,532.95 / $5,376.24 / $23,822.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,903.51 / $3,178.29 / $5,755.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,605.34 / $5,538.71 / $8,581.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,536.24 / $5,616.67 / $10,584.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,985.53 / $4,666.06 / $5,546.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,746.74 / $3,178.29 / $5,307.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,934.49 / $4,934.49 / $4,934.49