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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
$41.69 / $41.69 / $41.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $33.88 / $44.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $89.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $61.66 / $114.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $38.90 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $67.61 / $67.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $112.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $61.66 / $81.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $30.90 / $64.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54