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South Dakota rates for HCPCS L6882

Microprocessor control feature, addition to upper limb prosthetic terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,135.75 / $3,135.75 / $3,135.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,907.57 / $3,135.75 / $3,696.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.80 / $2,264.80 / $4,097.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,340.25 / $4,340.25 / $5,425.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,784.80 / $5,299.42 / $17,433.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.82 / $2,517.60 / $4,258.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,407.28 / $4,097.85 / $6,417.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,356.16 / $4,155.52 / $7,830.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,157.05 / $3,696.10 / $4,393.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.40 / $2,224.63 / $3,147.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,650.81 / $3,650.81 / $3,650.81