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New Hampshire rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.50 / $283.50 / $340.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.02 / $236.63 / $283.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.49 / $503.49 / $596.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.08 / $280.08 / $293.45
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.65 / $407.65 / $1,258.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.46 / $251.18 / $298.26
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.10 / $414.81 / $527.94