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South Dakota rates for HCPCS L5000

Partial foot, shoe insert with longitudinal arch, toe filler

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $575.44 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $436.52 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $676.08 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $407.38 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $691.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $1,096.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $407.38 / $724.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60