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South Dakota rates for HCPCS L3901

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,617.53 / $1,617.53 / $1,617.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.03 / $1,551.68 / $1,617.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $2,274.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,698.88 / $2,698.88 / $3,373.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,413.13 / $2,305.35 / $9,312.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$904.30 / $1,352.52 / $2,269.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,891.33 / $2,274.65 / $3,399.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.89 / $2,306.67 / $4,346.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.39 / $2,216.67 / $2,634.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.04 / $1,031.63 / $1,887.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.47 / $1,964.47 / $1,964.47