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South Dakota rates for HCPCS L4080

Replace metal bands KAFO, proximal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.17 / $83.17 / $83.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.90 / $83.17 / $86.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.33 / $84.33 / $151.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.75 / $140.13 / $173.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.33 / $131.65 / $593.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.40 / $72.63 / $150.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.25 / $151.86 / $218.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $153.97 / $290.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.05 / $111.28 / $132.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.51 / $68.86 / $135.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $131.15 / $131.15