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New Mexico rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.12 / $237.12 / $237.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.12 / $364.14 / $1,769.11
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 / $352.55 / $352.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.84 / $483.56 / $725.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $148.11 / $363.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $641.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.32 / $229.42 / $345.60