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Minnesota rates for HCPCS L4045

Replace nonmolded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $218.78 / $323.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $371.54 / $537.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,380.38 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $489.78 / $549.54
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,630.27
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $588.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $371.54 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $186.21 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $181.97 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $186.21 / $457.09