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South Dakota rates for HCPCS L3670

Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $107.15 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $85.11 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $91.20 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $131.83 / $234.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $95.50 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $181.97 / $181.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $223.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $125.89 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $79.43 / $134.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49