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South Dakota rates for HCPCS L6930

Below Elbow 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
$8,158.20 / $8,158.20 / $8,158.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,977.76 / $8,158.20 / $9,990.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,300.68 / $6,300.68 / $9,834.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,291.63 / $11,291.63 / $14,114.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,986.95 / $14,286.73 / $42,111.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,075.69 / $6,377.16 / $10,230.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,177.02 / $9,834.28 / $15,466.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,720.62 / $9,972.68 / $18,793.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,533.59 / $9,990.71 / $11,875.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,148.34 / $5,361.23 / $9,565.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,761.45 / $8,761.45 / $8,761.45