go back

South Dakota rates for HCPCS L6665

Upper extremity addition, Teflon, or equal, cable lining

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.30 / $46.30 / $46.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.14 / $46.30 / $53.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.54 / $34.54 / $60.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.13 / $64.13 / $80.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.24 / $64.98 / $279.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.02 / $36.77 / $65.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.56 / $60.80 / $106.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.80 / $61.66 / $116.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.11 / $53.98 / $64.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.59 / $36.77 / $48.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.16 / $54.16 / $54.16