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Maine rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.99 / $305.61 / $305.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.80 / $580.16 / $1,075.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.08 / $293.45 / $293.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $370.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $257.36 / $352.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.65 / $407.65 / $407.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.50 / $305.61 / $305.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.46 / $251.18 / $577.65