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South Dakota rates for HCPCS L3763

Elbow-wrist-hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.16 / $570.16 / $570.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.43 / $486.62 / $570.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $852.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.20 / $951.38 / $1,189.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.38 / $860.26 / $3,743.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.64 / $495.32 / $855.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.51 / $852.10 / $1,383.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.88 / $864.09 / $1,628.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.13 / $727.19 / $864.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.70 / $419.73 / $619.15
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.91 / $735.91 / $735.91