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South Dakota rates for HCPCS L7401

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.90 / $346.90 / $346.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.69 / $346.90 / $408.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $453.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $600.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.12 / $586.26 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $278.57 / $471.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.98 / $453.39 / $710.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.33 / $459.76 / $866.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.31 / $408.96 / $486.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $278.14 / $348.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.93 / $403.93 / $403.93