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Tennessee rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.90 / $206.90 / $226.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.06 / $224.41 / $387.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.00 / $413.88 / $413.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.82 / $352.55 / $352.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $257.36 / $352.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.60 / $2,469.31 / $2,912.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,369.92 / $3,450.78 / $4,077.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.94 / $229.42 / $327.99