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South Dakota rates for HCPCS L3450

Heel Sach Cushion Type (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.34 / $88.34 / $88.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.50 / $87.87 / $88.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.98 / $70.98 / $139.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.38 / $147.38 / $184.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.25 / $148.50 / $592.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.22 / $81.94 / $138.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.75 / $139.22 / $218.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.01 / $141.18 / $266.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.24 / $125.53 / $149.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.38 / $64.13 / $106.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23