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South Dakota rates for HCPCS L6621

Upper Extremity Prosthesis Addition Flexion/Extension Wrist With Or Without Friction For Use With External Powered Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.83 / $2,312.83 / $2,312.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,144.58 / $2,312.83 / $2,726.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $3,022.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,201.00 / $3,201.00 / $4,001.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,053.98 / $3,908.68 / $12,858.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.11 / $1,856.90 / $3,141.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,513.17 / $3,022.51 / $4,733.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,475.46 / $3,065.06 / $5,775.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,328.53 / $2,726.12 / $3,240.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.56 / $1,640.82 / $2,321.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,692.79 / $2,692.79 / $2,692.79