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South Dakota rates for HCPCS L3674

Shoulder Orthosis Abduction Positioning (Airplanedesign) Thoracic Component And Support Bar With Or Without Nontorsion Joint/Turnbuckle May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.59 / $900.59 / $900.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.25 / $895.78 / $900.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,418.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.63 / $1,502.63 / $1,878.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.58 / $1,513.87 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.04 / $871.65 / $1,474.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.70 / $1,418.78 / $2,222.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,162.00 / $1,438.75 / $2,711.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.03 / $1,279.68 / $1,521.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.30 / $673.93 / $1,089.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.31 / $1,225.31 / $1,225.31