go back

Texas rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.94 / $220.18 / $224.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.48 / $224.41 / $402.68
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.56 / $483.56 / $483.56
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 / $352.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.94 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $336.99 / $483.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.11 / $435.20 / $613.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.11 / $336.99 / $483.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $257.36 / $363.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.19 / $276.47 / $329.14
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.51 / $280.08 / $483.56