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South Dakota rates for HCPCS L3762

Elbow orthosis (EO), rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.91 / $81.91 / $81.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.85 / $69.58 / $81.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.50 / $136.50 / $170.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.47 / $137.68 / $549.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.48 / $75.97 / $128.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.32 / $129.07 / $202.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.71 / $130.88 / $246.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.41 / $116.38 / $138.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.14 / $59.45 / $99.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.47 / $111.47 / $111.47