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South Dakota rates for HCPCS L6677

Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $263.03 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $524.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $371.54 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $239.88 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $389.05 / $389.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $645.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $363.08 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $239.88 / $380.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74