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South Dakota rates for HCPCS L6920

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $8,511.38 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $7,079.46 / $8,511.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $11,748.98 / $14,791.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $9,772.37 / $26,302.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $6,165.95 / $48,977.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $10,000.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $17,378.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,128.31 / $9,772.37 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $6,025.60 / $10,232.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,912.51 / $8,912.51 / $8,912.51