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South Dakota rates for HCPCS L3001

Foot Insert Removable Molded To Patient Model Spenco Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.73 / $110.73 / $110.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.62 / $110.13 / $110.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.96 / $88.96 / $174.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.88 / $184.88 / $231.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.13 / $186.12 / $742.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.19 / $102.70 / $173.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.05 / $174.44 / $273.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.85 / $176.89 / $333.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.38 / $157.33 / $187.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.61 / $80.37 / $159.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.65 / $150.65 / $150.65