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South Dakota rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.04 / $562.04 / $562.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.12 / $562.04 / $662.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $734.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.75 / $777.75 / $972.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.11 / $949.86 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.25 / $451.23 / $763.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.69 / $734.45 / $1,150.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.52 / $744.80 / $1,403.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.83 / $662.46 / $787.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.15 / $398.72 / $564.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.33 / $654.33 / $654.33