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South Dakota rates for HCPCS L6691

Upper Extremity Addition Removable Insert Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.47 / $355.47 / $355.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.47 / $384.70 / $404.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.52 / $274.52 / $542.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.00 / $496.92 / $615.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.84 / $534.40 / $2,227.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.06 / $275.58 / $553.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.82 / $542.19 / $795.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.06 / $549.82 / $1,036.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.60 / $404.60 / $480.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.84 / $275.58 / $344.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.04 / $483.04 / $483.04