go back

Washington rates for HCPCS L4040

Replace Molded Thigh Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.79 / $939.30 / $980.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.83 / $413.79 / $980.68
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.90 / $1,167.64 / $2,469.31
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.37 / $521.19 / $3,369.92
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.38 / $582.50 / $1,317.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.69 / $582.50 / $975.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $470.05 / $517.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.80 / $528.05 / $613.16
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.05 / $551.84 / $613.16
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.90 / $688.61 / $1,197.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.61 / $598.79 / $598.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.10 / $521.19 / $674.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.12 / $247.47 / $437.71
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.43 / $189.43 / $521.19