go back

South Dakota rates for HCPCS L3030

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.88 / $63.88 / $63.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.32 / $63.52 / $187.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.54 / $61.54 / $100.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.50 / $106.50 / $133.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.52 / $107.35 / $428.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.02 / $59.23 / $100.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.69 / $100.64 / $157.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.43 / $102.06 / $192.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.52 / $90.74 / $107.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.08 / $46.36 / $77.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.92 / $86.92 / $86.92