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South Dakota rates for HCPCS L6881

Automatic grasp feature, addition to upper limb electric prosthetic terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,133.89 / $4,133.89 / $4,133.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,833.07 / $4,133.89 / $4,872.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,801.20 / $2,801.20 / $5,402.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,721.75 / $5,778.97 / $7,152.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,671.20 / $6,986.27 / $22,982.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,987.74 / $3,318.91 / $5,614.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,491.85 / $5,402.23 / $8,460.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,424.46 / $5,478.27 / $10,323.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,161.87 / $4,872.52 / $5,791.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,722.23 / $2,932.74 / $4,935.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,812.89 / $4,812.89 / $4,812.89