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Missouri rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.78 / $253.78 / $338.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.78 / $263.00 / $401.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.77 / $509.01 / $2,237.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.38 / $280.08 / $392.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $352.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $257.36 / $363.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.78 / $392.37 / $2,469.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.08 / $241.84 / $589.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.56 / $241.84 / $498.14