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South Dakota rates for HCPCS L6615

Upper Extremity Addition Disconnect Locking Wrist Unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.63 / $216.63 / $216.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.62 / $216.63 / $228.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.58 / $175.58 / $251.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.70 / $300.00 / $375.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.43 / $314.81 / $1,083.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.36 / $155.87 / $261.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.33 / $251.74 / $400.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.18 / $255.29 / $481.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.46 / $228.84 / $272.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.45 / $138.69 / $194.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.27 / $224.27 / $224.27