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South Dakota rates for HCPCS L6684

Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $467.74 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $323.59 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $467.74 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $302.00 / $3,090.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $457.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $812.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $302.00 / $575.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38