go back

South Dakota rates for HCPCS L3915

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnblocks May Include Soft Interface Straps Prefabricated Itemthat Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $405.00 / $405.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.38 / $402.84 / $405.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $325.37 / $638.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.75 / $675.75 / $844.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.84 / $680.80 / $2,714.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.77 / $375.63 / $636.17
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.52 / $638.03 / $999.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.55 / $647.02 / $1,219.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.56 / $575.48 / $684.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.40 / $293.99 / $489.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.03 / $551.03 / $551.03