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South Dakota rates for HCPCS L3660

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.73 / $78.73 / $78.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.50 / $40.15 / $101.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.80 / $74.27 / $156.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.25 / $156.10 / $164.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.96 / $151.55 / $589.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.33 / $89.65 / $141.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.79 / $156.10 / $217.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.79 / $158.30 / $298.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.35 / $144.43 / $171.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.26 / $70.79 / $122.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.81 / $134.81 / $134.81