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South Dakota rates for HCPCS L3671

Shoulder orthosis (SO), shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $562.34 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,862.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $630.96 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,071.52 / $1,071.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $501.19 / $1,047.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25