go back

South Dakota rates for HCPCS L3660

Shoulder orthosis (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $107.15 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $77.62 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $74.13 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $165.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $144.54 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $89.13 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $154.88 / $154.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $263.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $147.91 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $74.13 / $123.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90