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South Dakota rates for HCPCS L3984

Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.64 / $263.64 / $276.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.61 / $250.69 / $298.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $502.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.88 / $444.27 / $549.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.08 / $488.47 / $2,002.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.89 / $277.91 / $500.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.70 / $502.35 / $728.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.43 / $509.43 / $959.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.69 / $425.78 / $506.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.22 / $227.84 / $362.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.85 / $433.85 / $433.85