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South Dakota rates for HCPCS L6885

Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,269.50 / $4,269.50 / $4,269.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,009.78 / $3,733.38 / $4,269.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,297.39 / $3,297.39 / $4,241.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.20 / $5,909.25 / $7,386.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,828.67 / $6,309.41 / $19,929.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,523.03 / $2,542.98 / $4,537.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,527.07 / $4,241.89 / $7,336.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,474.14 / $4,301.60 / $8,106.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,188.87 / $3,733.38 / $4,437.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.35 / $2,542.98 / $3,387.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,779.14 / $3,779.14 / $3,779.14