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South Dakota rates for HCPCS L6647

Upper extremity addition, shoulder lock mechanism, body powered actuator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.04 / $525.04 / $525.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.83 / $525.04 / $618.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.51 / $405.51 / $686.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.75 / $726.75 / $908.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.29 / $887.33 / $2,919.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.49 / $421.58 / $713.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.50 / $686.14 / $1,074.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.94 / $695.77 / $1,311.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.65 / $618.91 / $735.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.80 / $421.58 / $664.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.28 / $611.28 / $611.28