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Arkansas rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.77 / $268.77 / $268.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.53 / $268.77 / $268.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.45 / $552.51 / $613.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.87 / $459.87 / $464.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.15 / $464.15 / $464.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $386.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $377.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.94 / $224.96 / $309.27