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South Dakota rates for HCPCS L6883

Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,008.64 / $2,008.64 / $2,008.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,938.01 / $2,008.64 / $2,008.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,551.30 / $1,551.30 / $2,731.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,656.96 / $2,780.25 / $3,475.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,696.88 / $3,394.60 / $9,894.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.50 / $1,368.31 / $2,570.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,271.09 / $2,731.39 / $3,655.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,186.37 / $2,769.83 / $5,219.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.85 / $2,008.83 / $2,387.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.00 / $1,266.94 / $1,710.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,433.42 / $2,433.42 / $2,433.42