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South Dakota rates for HCPCS L6688

Upper extremity addition, frame type socket, above elbow or elbow disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.78 / $641.78 / $641.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.91 / $620.91 / $641.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.47 / $528.47 / $735.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.49 / $888.38 / $1,110.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.27 / $817.87 / $3,410.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.30 / $422.94 / $764.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.63 / $735.58 / $1,220.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.46 / $745.95 / $1,405.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.37 / $620.91 / $738.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.37 / $422.94 / $1,011.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.34 / $655.34 / $655.34