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South Dakota rates for HCPCS L7190

Electronic elbow, adolescent, Variety Village or equal, myoelectronically controlled

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,484.91 / $8,484.91 / $8,484.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,139.76 / $8,484.91 / $9,465.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,553.03 / $6,553.03 / $10,062.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,743.88 / $11,743.88 / $14,679.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,190.23 / $14,339.50 / $46,975.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,861.40 / $6,447.37 / $10,761.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,366.86 / $10,062.58 / $17,400.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,262.11 / $10,204.21 / $19,229.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,084.91 / $9,465.41 / $11,251.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,541.87 / $6,031.35 / $8,059.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,964.84 / $8,964.84 / $8,964.84