HCPCS L4040
Replace molded thigh lacer, for custom fabricated orthosis only
Current code23 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $613 – $674 | — | — |
| Deaconess Medical Center | $613 – $674 | — | — |
| Harborview Medical Center | $625 – $688 | $766 | $1,094 |
| Kadlec Regional Medical Center | $625 – $751 | — | — |
| Mary Bridge Children's Hospital | $613 – $674 | — | — |
| MultiCare Auburn Medical Center | $613 – $674 | — | — |
| MultiCare Covington Medical Center | $613 – $674 | — | — |
| MultiCare Good Samaritan Hospital | $613 – $674 | — | — |
| MultiCare Valley Hospital | $631 – $674 | — | — |
| Overlake Hospital Medical Center & Clinics | $625 – $650 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $625 – $751 | — | — |
| Providence Centralia Hospital | $625 – $1,001 | — | — |
| Providence Regional Medical Center Everett | $625 – $688 | — | — |
| Providence St Peter Hospital | $625 – $1,001 | — | — |
| Swedish Edmonds Hospital | $625 – $751 | — | — |
| Swedish Issaquah | $625 – $751 | — | — |
| Swedish Medical Center | $625 – $751 | — | — |
| Swedish Medical Center / Cherry Hill | $625 – $751 | — | — |
| Tacoma General Allenmore Hospital | $613 – $674 | — | — |
| University of Washington Medical Ctr | $625 – $688 | $967 | $1,381 |
| Virginia Mason Medical Center | $429 – $644 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $613 – $686 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $625 (fee)