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South Dakota rates for HCPCS L6611

Addition to upper extremity prosthesis, external powered, additional switch, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.31 / $416.31 / $416.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.03 / $416.31 / $490.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.50 / $321.50 / $544.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.38 / $582.14 / $720.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.00 / $829.30 / $2,314.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.18 / $334.24 / $565.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.38 / $544.05 / $852.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.60 / $551.73 / $1,039.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.14 / $490.71 / $583.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.45 / $295.36 / $497.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.71 / $484.71 / $484.71