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South Dakota rates for HCPCS L3040

Foot Arch Support Removable Premolded Longitudinal Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.40 / $39.40 / $39.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $35.46 / $39.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $33.22 / $62.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.63 / $65.63 / $82.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.20 / $61.90 / $264.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.84 / $36.54 / $61.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.62 / $62.08 / $97.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $62.96 / $118.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.82 / $56.00 / $66.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.79 / $28.60 / $47.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.62 / $53.62 / $53.62