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South Dakota rates for HCPCS L3971

Shoulder-elbow-wrist-hand orthotic (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,434.61 / $1,434.61 / $1,434.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.68 / $1,426.88 / $1,434.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $2,260.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.63 / $2,393.63 / $2,992.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.88 / $2,411.42 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.57 / $1,330.50 / $2,253.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,879.16 / $2,260.02 / $3,539.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,850.95 / $2,291.81 / $4,318.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.11 / $2,038.40 / $2,422.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.49 / $1,073.54 / $1,735.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,951.83 / $1,951.83 / $1,951.83