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Wyoming rates for HCPCS L4040

Replace molded thigh lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.83 / $268.83 / $420.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.80 / $468.80 / $468.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.80 / $468.80 / $468.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $352.55 / $533.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.36 / $257.36 / $352.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.36 / $229.42 / $254.70