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South Dakota rates for HCPCS L6450

Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,596.05 / $3,596.05 / $3,596.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,262.35 / $3,596.05 / $4,818.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,717.61 / $2,717.61 / $4,597.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,977.38 / $4,977.38 / $6,221.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,856.45 / $5,011.01 / $19,464.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,928.03 / $2,927.92 / $4,933.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,823.05 / $4,597.87 / $7,101.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,163.04 / $4,662.60 / $8,845.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,115.55 / $4,818.29 / $5,727.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.49 / $2,461.48 / $4,102.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,096.28 / $4,096.28 / $4,096.28