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Arizona rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.61 / $245.26 / $413.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.97 / $581.53 / $1,051.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.44 / $536.59 / $731.11
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 / $257.36 / $580.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $413.79 / $2,469.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.15 / $229.42 / $345.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.36 / $229.42 / $345.60