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South Dakota rates for HCPCS L6650

Upper extremity addition, shoulder universal joint, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $691.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $436.52 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $2,570.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $446.68 / $446.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $724.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $407.38 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $489.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11