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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
$399.33 / $399.33 / $399.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.08 / $396.74 / $399.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.67 / $280.67 / $446.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.87 / $552.75 / $690.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.29 / $522.65 / $2,155.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.85 / $270.24 / $482.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.58 / $446.89 / $779.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.01 / $453.18 / $854.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.88 / $396.74 / $471.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.69 / $270.24 / $476.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.13 / $398.13 / $398.13