go back

South Dakota rates for HCPCS L2330

Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.37 / $307.37 / $307.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.68 / $292.25 / $333.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.03 / $345.03 / $515.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.00 / $515.72 / $641.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.31 / $563.29 / $2,336.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.25 / $310.79 / $525.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.81 / $515.72 / $848.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.38 / $522.97 / $985.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.71 / $476.15 / $565.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.80 / $245.01 / $508.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.46 / $459.46 / $459.46