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South Dakota rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.08 / $214.34 / $321.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.54 / $146.24 / $209.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $130.59 / $256.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.13 / $271.13 / $338.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.69 / $273.26 / $1,089.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.24 / $150.78 / $255.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.93 / $256.08 / $401.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.75 / $259.69 / $489.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.31 / $230.98 / $274.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.64 / $118.00 / $196.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.16 / $221.16 / $221.16