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Utah rates for HCPCS L4045

Replace nonmolded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $213.80 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $239.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $323.59 / $426.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $389.05 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $316.23 / $398.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $446.68 / $457.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $457.09 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $186.21 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $186.21 / $263.03