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South Dakota rates for HCPCS L3678

Shoulder Orthosis Shoulder Joint Design Without Joints May Include Soft Interface Straps Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $97.00 / $97.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.00 / $97.00 / $97.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.60 / $94.60 / $94.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.06 / $94.60 / $94.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.96 / $148.72 / $241.12