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West Virginia rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.79 / $239.79 / $239.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.53 / $229.49 / $244.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.70 / $620.82 / $812.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.70 / $324.91 / $551.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $606.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $352.55 / $2,543.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.29 / $247.47 / $385.93