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South Dakota rates for HCPCS L3931

Wrist-hand-finger orthosis (WHFO), includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $120.23 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $331.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $223.87 / $398.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $134.90 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $269.15 / $269.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $380.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $213.80 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $117.49 / $239.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42