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South Dakota rates for HCPCS L6693

Upper extremity addition, locking elbow, forearm counterbalance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,870.69 / $2,870.69 / $2,870.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,661.82 / $2,870.69 / $3,383.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,217.07 / $2,217.07 / $3,751.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,973.13 / $3,973.13 / $4,966.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,549.37 / $4,851.47 / $16,018.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.36 / $2,304.78 / $3,898.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,119.30 / $3,751.50 / $5,875.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,072.50 / $3,804.30 / $7,169.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,890.16 / $3,383.65 / $4,022.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.97 / $2,036.58 / $3,427.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,342.24 / $3,342.24 / $3,342.24