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South Dakota rates for HCPCS L3921

Hand-finger orthosis (HFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.74 / $244.74 / $244.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.16 / $243.39 / $244.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.98 / $212.98 / $385.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.38 / $408.38 / $510.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.39 / $411.33 / $1,640.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.85 / $226.95 / $384.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.55 / $385.51 / $603.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.74 / $390.95 / $736.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.99 / $347.70 / $413.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.90 / $183.13 / $296.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.94 / $332.94 / $332.94