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South Dakota rates for HCPCS L3570

Orthopedic Shoe Addition Special Extension To Instep (Leather With Eyelets) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.34 / $71.34 / $71.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.19 / $70.95 / $71.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.65 / $69.65 / $112.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.88 / $118.88 / $148.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.89 / $119.91 / $478.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.35 / $66.15 / $112.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.47 / $112.40 / $176.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $113.99 / $214.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.57 / $101.35 / $120.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.84 / $51.77 / $86.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.07 / $97.07 / $97.07