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Connecticut rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.33 / $275.33 / $275.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.85 / $269.87 / $275.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.02 / $566.48 / $648.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.29 / $283.29 / $296.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $290.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $290.63
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.21 / $368.21 / $368.21
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.21 / $396.54 / $566.48
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.49 / $295.49 / $295.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.69 / $282.61 / $471.02