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Illinois rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.13 / $257.13 / $257.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.48 / $257.13 / $400.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.84 / $1,011.44 / $4,304.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.89 / $352.55 / $533.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $580.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.24 / $856.02 / $1,220.89
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.36 / $650.36 / $650.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.42 / $403.46 / $423.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.47 / $249.58 / $438.23