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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

Facilitymedian $912 · 10th–90th $575–$9120%20%40%10th$912Professionalmedian $575 · 10th–90th $347–$9550%10%10th90th$575$500.0$1.0K$2.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $512.86 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $724.44 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $575.44 / $4,365.16
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $851.14 / $851.14
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $1,348.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $741.31 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $549.54 / $912.01
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31