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Idaho rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.61 / $536.90 / $536.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $384.59
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 / $431.91 / $613.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.84 / $582.50 / $613.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $452.50 / $538.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.90 / $598.79 / $898.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.21 / $429.21 / $643.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.12 / $229.42 / $409.70