go back

South Dakota rates for HCPCS L3915

Wrist-hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

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