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South Dakota rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Facilitymedian $195 · 10th–90th $158–$3630%20%40%10th90th$195Professionalmedian $195 · 10th–90th $93–$2880%10%10th90th$195$100.0$200.0$500.0$1.0K

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
$158.49 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $147.91 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $338.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $213.80 / $588.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $141.25 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $199.53 / $199.53
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $398.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $218.78 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $144.54 / $275.42
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83