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South Dakota rates for HCPCS L6623

Upper extremity addition, spring assisted rotational wrist unit with latch release

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.42 / $721.42 / $721.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.38 / $721.42 / $751.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.34 / $496.34 / $958.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.63 / $998.63 / $1,248.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.21 / $989.83 / $3,942.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.72 / $512.14 / $996.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.31 / $958.90 / $1,477.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.34 / $972.40 / $1,832.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.21 / $751.87 / $893.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.72 / $512.14 / $913.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.30 / $854.30 / $854.30