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South Dakota rates for HCPCS L6655

Upper extremity addition, standard control cable, extra

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.47 / $77.47 / $77.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.47 / $84.23 / $88.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.82 / $59.82 / $118.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.25 / $108.32 / $134.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.19 / $110.86 / $477.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.92 / $59.98 / $123.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.70 / $118.71 / $173.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.21 / $120.37 / $226.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.20 / $88.05 / $104.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.22 / $59.98 / $74.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.76 / $105.76 / $105.76