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South Dakota rates for HCPCS L3935

Finger orthosis (FO), nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.31 / $168.31 / $168.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.47 / $167.46 / $168.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.22 / $135.22 / $265.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.88 / $280.88 / $351.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.46 / $283.01 / $1,128.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.59 / $156.13 / $264.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.50 / $265.18 / $415.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.19 / $268.91 / $506.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.33 / $239.23 / $284.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.54 / $125.97 / $242.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.02 / $229.02 / $229.02