go back

South Dakota rates for HCPCS L3720

Elbow orthosis (EO), double upright with forearm/arm cuffs, free motion, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.59 / $550.83 / $550.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.26 / $492.92 / $520.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.57 / $450.57 / $830.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.50 / $868.50 / $1,085.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.92 / $833.03 / $3,794.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.27 / $459.62 / $855.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.50 / $830.45 / $1,383.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.15 / $842.13 / $1,586.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.46 / $704.17 / $837.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.67 / $397.84 / $599.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.20 / $717.20 / $717.20