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South Dakota rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Facilitymedian $631 · 10th–90th $603–$1,1750%20%40%10th90th$631Professionalmedian $603 · 10th–90th $372–$1,2590%20%10th90th$603$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $602.56 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $831.76 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $602.56 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $891.25 / $891.25
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $1,513.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $851.14 / $1,122.02
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $602.56 / $977.24
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25