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South Dakota rates for HCPCS L6632

Upper extremity addition, latex suspension sleeve, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $64.57 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $112.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $102.33 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $58.88 / $512.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $93.33 / $95.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $186.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $58.88 / $87.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11