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South Dakota rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Facilitymedian $372 · 10th–90th $331–$7410%20%40%10th90th$372Professionalmedian $372 · 10th–90th $195–$6030%10%20%10th90th$372$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $363.08 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $645.65
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $457.09 / $1,202.26
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $302.00 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $489.78 / $489.78
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $812.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $457.09 / $602.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $302.00 / $524.81
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52