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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
$294.75 / $294.75 / $294.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.06 / $232.97 / $499.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.50 / $243.27 / $446.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.44 / $491.63 / $614.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.36 / $393.72 / $1,920.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.78 / $217.24 / $445.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.22 / $446.45 / $654.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.64 / $452.73 / $853.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.27 / $332.82 / $395.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.13 / $198.37 / $283.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.57 / $385.57 / $385.57