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South Dakota rates for HCPCS L3766

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.52 / $1,034.52 / $1,034.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$930.73 / $1,028.95 / $1,034.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.10 / $831.10 / $1,629.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,726.13 / $1,726.13 / $2,157.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.95 / $1,738.93 / $6,933.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.66 / $959.45 / $1,624.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,355.10 / $1,629.73 / $2,552.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.76 / $1,652.67 / $3,114.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.54 / $1,469.93 / $1,747.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.54 / $774.14 / $1,578.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,407.49 / $1,407.49 / $1,407.49