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South Dakota rates for HCPCS L6616

Upper extremity addition, additional disconnect insert for locking wrist unit, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.20 / $65.20 / $65.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.76 / $65.20 / $76.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.36 / $50.36 / $85.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.38 / $90.38 / $112.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.12 / $91.87 / $404.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.02 / $51.78 / $92.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.20 / $85.64 / $149.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.14 / $86.84 / $163.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.94 / $76.03 / $90.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.41 / $51.78 / $66.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.29 / $76.29 / $76.29