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Iowa rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.60 / $347.60 / $349.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.53 / $276.20 / $410.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $533.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.55 / $580.13 / $725.16
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.82 / $566.83 / $1,022.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.52 / $612.46 / $2,469.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.38 / $259.20 / $662.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.69 / $533.25 / $698.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.73 / $622.90 / $1,019.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.38 / $241.84 / $635.84
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.53 / $460.53 / $460.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.82 / $460.53 / $460.53