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Washington, DC rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.36 / $190.36 / $190.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.36 / $190.36 / $190.36
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.00 / $249.00 / $317.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $212.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.32 / $302.32 / $923.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $232.04 / $348.64