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South Dakota rates for HCPCS L3809

Wrist-hand-finger orthosis (WHFO), without joint(s), prefabricated, off-the-shelf, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $25.26 / $190.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.37 / $168.70 / $190.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.00 / $146.03 / $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
$192.18 / $320.19 / $1,281.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.42 / $160.94 / $294.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.51 / $300.07 / $470.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.20 / $311.83 / $710.15
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
$95.68 / $184.36 / $290.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.14 / $259.14 / $259.14