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South Dakota rates for HCPCS L3090

Foot Arch Support Non-Removable Attached To Shoe Longitudinal/Metatarsal Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.08 / $34.08 / $34.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.64 / $33.86 / $34.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.38 / $27.38 / $53.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $57.00 / $71.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.34 / $53.49 / $228.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.73 / $31.58 / $53.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.62 / $53.66 / $84.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.96 / $54.42 / $102.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.33 / $48.37 / $57.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.11 / $24.71 / $41.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.34 / $46.34 / $46.34