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New Hampshire rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $257.04 / $537.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $549.54 / $630.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $354.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $234.42 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $251.19 / $436.52
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $724.44