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South Dakota rates for HCPCS L3900

Wrist-hand-finger orthosis (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.23 / $1,234.23 / $1,234.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.14 / $1,121.04 / $1,234.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.35 / $891.35 / $1,962.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,909.52 / $2,059.13 / $2,573.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,219.51 / $1,670.14 / $7,437.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.29 / $909.26 / $1,949.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.18 / $1,962.99 / $2,737.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.69 / $1,990.60 / $3,751.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.88 / $1,393.05 / $1,655.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.22 / $830.26 / $1,523.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.31 / $1,695.31 / $1,695.31