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South Dakota rates for HCPCS L3924

Hand-finger orthosis (HFO), without joints, may include soft interface, straps, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.59 / $73.59 / $73.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.04 / $61.51 / $73.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.32 / $61.21 / $107.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.23 / $122.63 / $153.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.98 / $110.80 / $474.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.21 / $63.78 / $113.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.56 / $107.70 / $184.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.40 / $111.93 / $278.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.98 / $93.65 / $111.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.46 / $55.81 / $90.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.01 / $93.01 / $93.01