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South Dakota rates for HCPCS L3000

Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $213.80 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $371.54 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $239.88 / $1,905.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $416.87 / $416.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $691.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $380.19 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $398.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81