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Utah 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
$119.03 / $119.03 / $119.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.03 / $165.04 / $1,421.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.92 / $230.92 / $230.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.57 / $230.92 / $237.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.33 / $324.74 / $422.16
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.50 / $434.40 / $434.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.36 / $311.38 / $467.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.36 / $184.37 / $236.06