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Nebraska rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.14 / $309.14 / $309.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.14 / $309.14 / $401.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.06 / $468.68 / $473.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $533.25 / $533.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.55 / $533.25 / $822.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.65 / $530.62 / $2,469.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.77 / $241.84 / $403.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.69 / $533.25 / $698.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.38 / $630.20 / $1,098.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.77 / $241.84 / $345.25