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South Dakota rates for HCPCS L3020

Foot Insert Removable Molded To Patient Model Longitudinal/ Metatarsal Support Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.10 / $166.10 / $166.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.25 / $149.43 / $415.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.55 / $153.72 / $261.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.13 / $277.13 / $346.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.19 / $279.17 / $1,113.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.27 / $154.03 / $260.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.56 / $261.67 / $409.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.31 / $265.33 / $500.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.57 / $235.99 / $280.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.41 / $124.29 / $253.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.99 / $225.99 / $225.99