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South Dakota rates for HCPCS L7402

Addition To Upper Extremity Prosthesis Shoulder Disarticulation/Interscapular Thoracic Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.68 / $374.68 / $374.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.43 / $374.68 / $441.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $489.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.63 / $518.63 / $648.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.73 / $633.21 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.16 / $300.81 / $508.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.15 / $489.67 / $766.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.03 / $496.57 / $935.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.22 / $441.61 / $524.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $300.81 / $474.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.25 / $436.25 / $436.25