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South Dakota rates for HCPCS L6350

Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,917.77 / $4,917.77 / $4,917.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,418.03 / $4,917.77 / $5,361.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,798.08 / $3,798.08 / $6,226.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,806.63 / $6,806.63 / $8,508.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,868.32 / $6,044.03 / $24,802.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.14 / $3,651.86 / $6,470.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,177.35 / $6,226.65 / $9,021.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,099.66 / $6,314.29 / $11,899.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,579.38 / $5,361.31 / $6,372.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,836.43 / $3,127.21 / $4,564.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,547.38 / $5,547.38 / $5,547.38