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South Dakota rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.90 / $54.90 / $54.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.04 / $43.19 / $49.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $69.00 / $85.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.34 / $91.50 / $114.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.03 / $75.54 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.05 / $43.50 / $85.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.98 / $85.37 / $125.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.91 / $86.56 / $163.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.54 / $63.85 / $75.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.54 / $38.06 / $54.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $73.73 / $73.73