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South Dakota rates for HCPCS L3765

Elbow Wrist Hand Finger Orthosis 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
$976.94 / $976.94 / $976.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.94 / $971.70 / $976.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $1,539.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,630.13 / $1,630.13 / $2,037.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$971.70 / $1,642.17 / $6,547.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.29 / $906.06 / $1,534.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,279.69 / $1,539.04 / $2,410.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.49 / $1,560.71 / $2,941.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.68 / $1,388.14 / $1,650.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.64 / $709.15 / $1,181.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.17 / $1,329.17 / $1,329.17