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Maryland rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.36 / $220.88 / $363.59
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.00 / $249.00 / $317.94
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.57 / $465.10 / $669.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.00 / $232.04 / $369.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.64 / $278.64 / $325.57