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South Dakota rates for HCPCS L3540

Orthopedic shoe addition, sole, full

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.58 / $42.58 / $42.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.31 / $42.36 / $42.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.72 / $36.72 / $67.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.88 / $70.88 / $88.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.24 / $71.59 / $285.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.70 / $39.51 / $66.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.78 / $67.09 / $105.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.94 / $68.04 / $128.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.71 / $60.52 / $71.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.39 / $31.88 / $61.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.94 / $57.94 / $57.94