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South Dakota rates for HCPCS L3420

Full sole and heel wedge, between sole

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $37.15 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $95.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $66.07 / $125.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $41.69 / $331.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $72.44 / $72.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $120.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $66.07 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $33.11 / $69.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66