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South Dakota rates for HCPCS L6648

Upper extremity addition, shoulder lock mechanism, external powered actuator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,289.20 / $3,289.20 / $3,289.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,049.86 / $3,289.20 / $3,876.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,540.30 / $2,540.30 / $4,298.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,552.50 / $4,552.50 / $5,690.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,921.06 / $5,558.75 / $18,286.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,581.60 / $2,640.78 / $4,466.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,574.03 / $4,298.38 / $6,732.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,520.40 / $4,358.89 / $8,214.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.51 / $3,876.96 / $4,608.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.33 / $1,980.59 / $3,300.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,829.47 / $3,829.47 / $3,829.47