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South Dakota rates for HCPCS L3671

Shoulder Orthosis Shoulder Joint Design Without Joints May Includ Soft Interface Straps Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.51 / $686.51 / $686.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.12 / $583.13 / $682.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.53 / $551.53 / $1,081.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.25 / $1,145.25 / $1,431.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.82 / $1,153.97 / $4,601.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.94 / $636.70 / $1,078.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.24 / $1,081.49 / $1,693.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.73 / $1,096.70 / $2,066.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.19 / $975.45 / $1,159.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.78 / $498.32 / $830.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$934.01 / $934.01 / $934.01