go back

South Dakota rates for HCPCS L4045

Replace Non-Molded Thigh Laser For Custom Fabricated Orthosis Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.77 / $256.77 / $256.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.96 / $256.77 / $304.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.92 / $230.92 / $437.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.25 / $432.53 / $535.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.38 / $475.58 / $1,940.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.40 / $282.13 / $444.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.94 / $437.70 / $709.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.17 / $443.86 / $836.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.04 / $434.40 / $516.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.36 / $221.92 / $369.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.01 / $378.01 / $378.01