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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
$45.79 / $45.79 / $45.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.18 / $45.53 / $45.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.78 / $36.78 / $72.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.50 / $77.27 / $95.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $76.95 / $306.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.54 / $42.46 / $71.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.96 / $72.12 / $112.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.08 / $73.14 / $137.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.57 / $65.04 / $77.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.99 / $33.22 / $55.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.28 / $62.28 / $62.28