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South Dakota rates for HCPCS L6620

Upper Extremity Addition Flexion/Extension Wrist Unit With Or Without Friction. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.70 / $378.70 / $378.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.54 / $378.70 / $398.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.48 / $292.48 / $501.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.48 / $524.25 / $655.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.30 / $486.78 / $1,897.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.66 / $271.60 / $502.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.64 / $501.08 / $698.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.39 / $508.13 / $957.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.59 / $398.74 / $473.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.16 / $271.60 / $452.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.42 / $446.42 / $446.42