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South Dakota rates for HCPCS L3224

Orthopedic footwear, woman's shoe, Oxford, used as an integral part of a brace (orthosis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.57 / $56.57 / $56.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.09 / $50.87 / $56.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.83 / $55.83 / $89.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $94.50 / $118.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.33 / $79.58 / $362.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.45 / $43.91 / $88.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.06 / $89.07 / $127.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.95 / $90.33 / $170.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.47 / $67.27 / $79.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.88 / $38.56 / $58.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.92 / $76.92 / $76.92