go back

South Dakota rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.47 / $291.47 / $291.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.25 / $254.87 / $291.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $352.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.09 / $403.50 / $504.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.12 / $326.02 / $1,446.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.98 / $173.61 / $366.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.26 / $352.68 / $500.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.86 / $357.66 / $673.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.70 / $254.87 / $302.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.95 / $196.18 / $347.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.20 / $314.20 / $314.20