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South Dakota rates for HCPCS L3250

Orthopedic Footwear Custom Molded Shoe Removable Inner Mold Prosthetic Shoe Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.12 / $166.12 / $166.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.12 / $153.56 / $166.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.82 / $401.63 / $502.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.26 / $307.12 / $1,166.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.26 / $189.21 / $353.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.64 / $358.75 / $506.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.44 / $358.75 / $551.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.74 / $190.26 / $245.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.88 / $216.88 / $216.88