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South Dakota rates for HCPCS L6500

Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,531.26 / $3,531.26 / $3,531.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,522.15 / $3,531.26 / $4,738.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,970.85 / $2,970.85 / $4,964.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,887.38 / $4,936.25 / $6,109.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,083.93 / $4,927.75 / $19,143.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,932.95 / $2,930.32 / $5,158.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,127.51 / $4,964.04 / $7,107.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,135.87 / $5,033.91 / $9,486.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,047.16 / $4,738.20 / $5,632.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.69 / $3,227.42 / $4,426.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,422.50 / $4,422.50 / $4,422.50