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South Dakota rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Facilitymedian $794 · 10th–90th $661–$1,5140%20%40%10th90th$794Professionalmedian $794 · 10th–90th $380–$1,2020%10%10th90th$794$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $724.44 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $933.25 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $616.60 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $977.24 / $1,000.00
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $912.01 / $1,202.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $616.60 / $1,122.02
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25