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South Dakota rates for HCPCS L3967

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Facilitymedian $1,660 · 10th–90th $1,514–$2,6920%20%40%10th90th$1,660Professionalmedian $1,514 · 10th–90th $977–$3,0200%20%10th90th$1,514$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,513.56 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,137.96 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,479.11 / $10,964.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,398.83 / $2,398.83
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $2,454.71
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $3,981.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,187.76 / $2,884.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,479.11 / $2,454.71
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,041.74 / $2,041.74