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Alaska rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.90 / $656.90 / $656.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $352.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $363.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $148.11 / $148.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.50 / $728.50 / $1,150.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $148.11 / $352.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $363.13 / $583.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.63 / $733.25 / $956.42