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South Dakota rates for HCPCS L6935

Below Elbow External Power Self-Suspended Inner Socket Removable Forearm Shell Otto Bock Or Equal Electrodes Cables Two Batteries And One Charger Myoelectronic Control Of Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,006.70 / $9,006.70 / $9,006.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,890.11 / $9,006.70 / $10,726.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,503.37 / $7,503.37 / $11,120.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,466.13 / $12,466.13 / $15,582.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,685.60 / $15,338.57 / $48,813.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,375.76 / $7,306.19 / $11,556.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,246.18 / $11,120.11 / $18,078.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,362.66 / $11,276.64 / $21,250.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,161.86 / $10,726.27 / $12,749.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,679.94 / $7,081.25 / $14,193.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,907.01 / $9,907.01 / $9,907.01