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South Dakota rates for HCPCS L6690

Upper Extremity Addition Frame Type Socket Interscapular- Thoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.52 / $900.52 / $900.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.98 / $805.96 / $900.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.50 / $695.50 / $962.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.03 / $1,246.50 / $1,558.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.41 / $1,061.53 / $4,434.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.79 / $548.98 / $1,000.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.36 / $962.58 / $1,583.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.35 / $976.12 / $1,839.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.41 / $805.96 / $958.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.38 / $548.98 / $731.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.57 / $857.57 / $857.57