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South Dakota rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Facilitymedian $575 · 10th–90th $562–$1,2590%50%10th90th$575Professionalmedian $589 · 10th–90th $269–$1,0000%10%20%10th90th$589$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $575.44 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $575.44 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $758.58 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $478.63 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $776.25 / $776.25
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $1,380.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $758.58 / $1,023.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $478.63 / $812.83
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83