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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
$57.54 / $72.44 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $64.57 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $61.66 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $154.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $102.33 / $177.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $64.57 / $524.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $107.15 / $107.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $173.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $95.50 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $53.70 / $112.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33