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South Dakota rates for HCPCS L3908

Wrist-hand orthosis (WHO), wrist extension control cock-up, nonmolded, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $28.84 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $52.48 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $117.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $67.61 / $123.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $52.48 / $93.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $74.13 / $74.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $117.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $66.07 / $87.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $36.31 / $81.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10