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Hand Restoration, Replacement Glove

South Dakota rates for HCPCS L6915

Hand restoration (shading and measurements included), replacement glove for above

Rates data updated July 2026.

Facilitymedian $832 · 10th–90th $562$1,4790%5%10%10th90th$832Professionalmedian $776 · 10th–90th $575$1,4130%20%10th90th$776$500.0$1.0K$2.0K$5.0K

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
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$741.31
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$1,122.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,412.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$933.25
Typical High
$1,995.26
Medica
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$575.44
Typical High
$4,677.35
Midlands
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,096.48
Typical High
$1,096.48
Midlands
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Midlands
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$1,348.96
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$758.58
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$562.34
Typical High
$630.96
United
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$575.44
Typical High
$1,148.15
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00