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Massachusetts rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.51 / $247.51 / $247.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.51 / $247.51 / $329.79
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.59 / $941.10 / $2,945.62
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.66 / $368.01 / $553.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.66 / $327.66 / $973.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $327.66 / $397.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $574.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.66 / $458.66 / $481.59
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.49 / $295.49 / $295.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.21 / $2,945.62 / $2,945.62
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.37 / $282.61 / $553.20
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 / $553.20