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Arkansas rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.52 / $258.52 / $258.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.70 / $258.52 / $269.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.51 / $531.41 / $590.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.10 / $465.10 / $465.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.10 / $465.10 / $465.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $372.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $363.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $221.69 / $312.81