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South Dakota rates for HCPCS L3807

Wrist-hand-finger orthosis (WHFO), without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.90 / $23.90 / $190.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.56 / $147.11 / $189.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.00 / $135.00 / $300.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $397.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.46 / $320.19 / $1,281.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.42 / $176.66 / $299.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.51 / $300.07 / $470.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.78 / $304.32 / $573.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.18 / $270.66 / $321.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.83 / $193.80 / $315.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.14 / $259.14 / $259.14