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North Carolina rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.68 / $402.68 / $694.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.33 / $402.68 / $402.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.70 / $442.44 / $840.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.13 / $344.90 / $344.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.47 / $352.55 / $352.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $580.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $402.68 / $523.48
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.00 / $259.00 / $312.68
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.50 / $652.50 / $1,003.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.27 / $229.42 / $345.60
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.60 / $2,912.51 / $2,912.51
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,450.78 / $3,450.78 / $4,077.98