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South Dakota rates for HCPCS L3520

Orthopedic shoe addition, insole, felt covered with leather

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $20.89 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $21.38 / $42.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $54.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $38.90 / $72.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $24.55 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $41.69 / $41.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $42.66 / $42.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $69.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $38.90 / $51.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.50 / $40.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31