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South Dakota rates for HCPCS L3919

Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.33 / $206.33 / $206.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.34 / $185.65 / $206.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.58 / $176.58 / $325.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $344.25 / $430.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.24 / $346.86 / $1,382.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.61 / $191.38 / $324.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.30 / $325.08 / $509.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.24 / $329.66 / $621.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.44 / $293.20 / $348.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.64 / $154.41 / $249.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.75 / $280.75 / $280.75