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South Dakota rates for HCPCS L3904

Wrist-hand-finger orthosis (WHFO), external powered, electric, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,571.69 / $2,571.69 / $2,571.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,028.07 / $2,571.69 / $2,942.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $3,551.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,290.75 / $4,290.75 / $5,363.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,484.27 / $4,371.76 / $17,217.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.52 / $2,464.66 / $4,243.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,952.77 / $3,551.23 / $6,195.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,215.36 / $3,669.24 / $7,716.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,590.54 / $4,203.63 / $4,996.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,261.08 / $2,147.48 / $3,831.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,066.97 / $3,066.97 / $3,066.97