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South Dakota rates for HCPCS L5000

Partial Foot Shoe Insert With Longitudinal Arch Toe Filler (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.64 / $494.44 / $592.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.90 / $459.90 / $696.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.13 / $802.13 / $1,002.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.44 / $780.89 / $3,120.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.60 / $403.39 / $724.17
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.42 / $696.86 / $1,163.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.72 / $706.66 / $1,331.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.85 / $592.22 / $703.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.89 / $403.39 / $691.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.84 / $620.84 / $620.84