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South Dakota rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Facilitymedian $89 · 10th–90th $71–$1480%20%40%10th90th$89Professionalmedian $87 · 10th–90th $58–$1480%10%20%10th90th$87$50.0$100.0$200.0$500.0

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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $70.79 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $120.23 / $147.91
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $117.49 / $190.55
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $72.44 / $676.08
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $144.54 / $144.54
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $181.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $72.44 / $120.23
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03