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South Dakota rates for HCPCS L3265

Plastazote Sandal, Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.08 / $10.08 / $10.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $9.32 / $14.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $28.65 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.38 / $21.36 / $22.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.27 / $18.64 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.18 / $11.49 / $21.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $21.79 / $30.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.29 / $22.08 / $36.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.33 / $10.11 / $16.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.55 / $44.55 / $44.55