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Nebraska rates for HCPCS L4045

Replace nonmolded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.75 / $253.75 / $253.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.75 / $253.75 / $329.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.72 / $384.69 / $388.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.92 / $437.70 / $437.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.92 / $437.70 / $674.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.35 / $435.54 / $1,940.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.05 / $198.51 / $330.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.41 / $437.70 / $561.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.00 / $517.28 / $901.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.91 / $198.51 / $277.45