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South Dakota rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.76 / $70.76 / $70.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.55 / $70.76 / $81.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $143.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.13 / $119.31 / $147.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.15 / $122.08 / $538.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.53 / $64.84 / $143.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.32 / $143.51 / $195.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.78 / $145.52 / $274.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.86 / $99.35 / $118.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.74 / $59.21 / $84.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.94 / $123.94 / $123.94