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South Dakota rates for HCPCS L3252

Foot Shoe Molded To Patient Model Plastazote (Or Similar) Custom Fabricated Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.00 / $91.00 / $91.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.47 / $84.12 / $91.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.50 / $56.50 / $56.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.88 / $138.24 / $171.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.80 / $168.24 / $638.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.78 / $103.65 / $196.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.70 / $196.53 / $277.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.05 / $199.13 / $301.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.07 / $91.20 / $132.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.88 / $216.88 / $216.88