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South Dakota rates for HCPCS L3808

Wrist-hand-finger orthosis (WHFO), rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.41 / $360.99 / $494.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.25 / $219.25 / $275.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.36 / $233.36 / $412.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.00 / $453.00 / $566.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.92 / $464.77 / $1,920.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.61 / $256.43 / $499.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.94 / $412.43 / $700.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.93 / $418.24 / $788.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.57 / $392.87 / $532.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.60 / $202.20 / $334.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.19 / $356.19 / $356.19