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South Dakota rates for HCPCS L6310

Shoulder Disarticulation Passive Restoration (Complete Prosthesis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,067.67 / $4,067.67 / $4,067.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.03 / $3,556.90 / $4,067.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,141.52 / $3,141.52 / $4,886.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,753.21 / $5,629.88 / $7,037.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,035.65 / $4,682.51 / $18,963.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,451.03 / $2,422.78 / $4,823.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,062.89 / $4,886.33 / $6,989.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,001.94 / $4,955.10 / $9,337.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,038.12 / $3,556.90 / $4,227.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.76 / $2,422.78 / $6,410.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,353.28 / $4,353.28 / $4,353.28