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South Dakota rates for HCPCS L3003

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.85 / $145.85 / $145.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.25 / $145.08 / $145.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.11 / $149.11 / $229.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.38 / $243.38 / $304.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.08 / $229.16 / $977.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.56 / $135.29 / $229.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.09 / $229.83 / $359.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.23 / $233.06 / $439.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.03 / $207.26 / $246.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.26 / $105.88 / $176.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.49 / $198.49 / $198.49