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South Dakota rates for HCPCS L3000

Foot Insert Removable Molded To Patient Model Ucb Type Berkeley Shell Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.98 / $262.98 / $262.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.06 / $223.36 / $790.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.27 / $211.27 / $414.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.75 / $438.75 / $548.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.54 / $413.10 / $1,762.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.41 / $243.86 / $413.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.49 / $414.30 / $648.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.31 / $420.14 / $791.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.13 / $373.63 / $444.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.07 / $190.87 / $318.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.81 / $357.81 / $357.81