go back

South Dakota rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $501.19 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,174.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $812.83 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $489.78 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $851.14 / $851.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,230.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $457.09 / $831.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58