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Massachusetts rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.99 / $219.99 / $219.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.99 / $219.99 / $304.52
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.59 / $941.10 / $2,912.51
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.32 / $360.36 / $491.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.23 / $291.23 / $864.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.23 / $352.55 / $352.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $580.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.65 / $407.65 / $428.03
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.83 / $278.83 / $278.83
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.94 / $2,912.51 / $2,912.51
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.19 / $251.18 / $491.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.80 / $251.18 / $491.69