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South Dakota rates for HCPCS L3050

Foot, arch support, removable, premolded, metatarsal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $32.36 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $81.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $56.23 / $107.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $36.31 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $61.66 / $61.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $102.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $57.54 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $28.84 / $60.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70