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South Dakota rates for HCPCS L3761

Elbow Orthosis (Eo) With Adjustable Position Locking Joint(S) Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.04 / $381.04 / $381.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.80 / $344.89 / $379.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $383.66 / $600.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.63 / $635.63 / $794.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.61 / $640.46 / $2,563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.29 / $368.77 / $591.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.10 / $600.26 / $1,147.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.10 / $623.79 / $1,420.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.66 / $554.38 / $733.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.35 / $285.12 / $460.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.41 / $518.41 / $518.41