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Vermont rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.70 / $245.70 / $283.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $370.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $363.13
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $370.06
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $363.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.46 / $298.26 / $582.07