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South Dakota rates for HCPCS L6704

Terminal device, sport/recreational/work attachment, any material, any size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.69 / $682.69 / $682.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.53 / $682.69 / $843.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.25 / $527.25 / $885.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.00 / $945.00 / $1,181.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.33 / $1,426.11 / $3,676.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $556.16 / $920.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.55 / $885.83 / $1,348.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.57 / $898.30 / $1,692.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.77 / $843.85 / $1,003.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.57 / $467.56 / $718.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.19 / $789.19 / $789.19