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South Dakota rates for HCPCS L3520

Orthopedic Shoe Addition Insole Felt Covered With Leather (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.62 / $26.62 / $26.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.94 / $26.47 / $26.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $21.38 / $41.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.25 / $44.25 / $55.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.65 / $44.73 / $178.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.43 / $24.68 / $41.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.86 / $41.92 / $65.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.34 / $42.53 / $80.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.29 / $37.82 / $44.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.36 / $19.91 / $32.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.20 / $36.20 / $36.20