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South Dakota rates for HCPCS L6641

Upper extremity addition, excursion amplifier, pulley type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $141.25 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $346.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $239.88 / $512.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $144.54 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $257.04 / $257.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $346.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $194.98 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $128.82 / $239.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09