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South Dakota rates for HCPCS L3925

Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.05 / $50.05 / $50.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.67 / $35.94 / $65.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $77.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.97 / $83.63 / $104.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.87 / $63.89 / $286.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.68 / $34.69 / $73.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.08 / $77.06 / $104.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $78.15 / $147.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.39 / $53.14 / $63.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $31.68 / $64.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56