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Montana rates for HCPCS L4045

Replace nonmolded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.16 / $1,421.69 / $1,421.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.92 / $467.07 / $467.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.92 / $379.82 / $467.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.03 / $444.83 / $467.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.92 / $350.55 / $467.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.63 / $184.37 / $282.13