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South Dakota rates for HCPCS L3980

Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $295.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $218.78 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $245.47 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $616.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $371.54 / $645.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $218.78 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $446.68 / $446.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $616.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $199.53 / $436.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05