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South Dakota rates for HCPCS L6895

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

Facilitymedian $676 · 10th–90th $525–$1,1480%50%10th90th$676Professionalmedian $661 · 10th–90th $295–$9550%20%10th90th$661$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $630.96 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $1,174.90
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $724.44 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $512.86 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $851.14 / $851.14
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $1,230.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $691.83 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $512.86 / $954.99
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58