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South Dakota rates for HCPCS L3931

Wrist Hand Finger Orthosis Includes One Or More Nontorsion Joint(S) Turn- Buckles Elastic Bands/Springs May Include Soft Interface Material Straps Pre- Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.86 / $158.86 / $158.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.94 / $152.13 / $158.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.61 / $125.61 / $271.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.13 / $271.36 / $331.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.84 / $245.95 / $1,045.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.81 / $135.69 / $270.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.96 / $271.76 / $385.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.58 / $275.58 / $519.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.58 / $207.90 / $247.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.52 / $117.01 / $178.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.70 / $234.70 / $234.70