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South Dakota rates for HCPCS L3906

Wrist-hand orthosis (WHO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.10 / $442.55 / $442.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.62 / $287.79 / $386.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.31 / $293.31 / $484.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.25 / $644.25 / $805.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.18 / $520.82 / $2,269.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.61 / $287.37 / $517.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.03 / $484.70 / $835.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.00 / $491.54 / $926.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.05 / $440.26 / $523.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.16 / $253.54 / $374.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.61 / $418.61 / $418.61