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Indiana rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.61 / $247.61 / $500.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.09 / $247.61 / $268.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.22 / $447.75 / $500.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.00 / $280.08 / $386.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.21 / $550.30 / $700.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.24 / $550.30 / $675.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $500.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $513.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.94 / $239.17 / $345.67