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South Dakota rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $355 · 10th–90th $347$6030%20%40%10th90th$355Professionalmedian $380 · 10th–90th $209$7240%20%10th90th$380$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $346.74 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $724.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $478.63 / $870.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $331.13 / $4,365.16
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $575.44 / $575.44
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $831.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $467.74 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $346.74 / $562.34
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19