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South Carolina rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $257.04 / $398.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $457.09 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $354.81 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $575.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $281.84 / $309.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $363.08 / $741.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $147.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $309.03