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South Dakota rates for HCPCS L6672

Upper Extremity Addition Harness Chest Or Shoulder Saddle Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.25 / $221.25 / $221.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.08 / $221.25 / $237.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.89 / $170.89 / $222.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.38 / $306.38 / $382.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.02 / $267.20 / $1,122.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.70 / $160.13 / $242.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.24 / $222.79 / $388.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.71 / $225.92 / $435.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.46 / $237.03 / $281.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.06 / $134.62 / $201.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.49 / $198.49 / $198.49