go back

South Dakota rates for HCPCS L2350

Addition to lower extremity, prosthetic type, (BK) socket, molded to patient model, (used for PTB, AFO orthoses)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.50 / $697.50 / $697.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.90 / $697.50 / $801.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.26 / $627.26 / $1,208.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.63 / $1,208.04 / $1,454.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.51 / $1,292.31 / $5,394.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.73 / $747.37 / $1,204.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.47 / $1,208.04 / $1,926.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.45 / $1,225.03 / $2,308.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.02 / $1,145.02 / $1,361.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.13 / $584.28 / $974.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.26 / $1,076.26 / $1,076.26