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South Dakota rates for HCPCS L6689

Upper Extremity Addition Frame Type Socket Shoulder Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$764.88 / $764.88 / $764.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.47 / $764.88 / $1,053.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.92 / $649.92 / $918.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.63 / $1,058.63 / $1,323.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$633.53 / $1,095.14 / $4,278.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.01 / $639.89 / $1,069.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.42 / $918.16 / $1,551.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.31 / $931.07 / $1,933.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.45 / $1,053.03 / $1,251.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.91 / $537.95 / $896.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.00 / $818.00 / $818.00