go back

South Dakota rates for HCPCS L3916

Wrist-hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf

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 / $682.51 / $844.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.44 / $589.29 / $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
$636.17 / $663.05 / $1,509.73
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
$216.48 / $391.99 / $618.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.03 / $551.03 / $551.03