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South Dakota rates for HCPCS L7191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,307.38 / $11,307.38 / $11,307.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,934.78 / $11,307.38 / $13,892.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,732.85 / $8,732.85 / $14,001.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,650.25 / $15,650.25 / $19,562.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,785.93 / $19,866.25 / $58,756.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,667.41 / $8,777.90 / $14,550.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,642.26 / $14,001.82 / $21,289.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,126.38 / $14,198.90 / $26,757.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,866.29 / $13,892.48 / $16,513.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,333.57 / $7,379.52 / $11,828.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,474.35 / $12,474.35 / $12,474.35