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South Dakota rates for HCPCS L3003

Foot insert, removable, molded to patient model, silicone gel, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $302.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $208.93 / $398.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $134.90 / $1,047.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $229.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $380.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $213.80 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $104.71 / $223.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53