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South Dakota rates for HCPCS L6695

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

Facilitymedian $661 · 10th–90th $562–$1,2590%20%40%10th90th$661Professionalmedian $661 · 10th–90th $324–$1,0230%10%10th90th$661$200.0$500.0$1.0K$2.0K

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
$549.54 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $602.56 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,148.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $776.25 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $512.86 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $812.83 / $831.76
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $1,348.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $1,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $512.86 / $933.25
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31