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Maine rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.51 / $343.84 / $343.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.83 / $652.75 / $1,210.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.29 / $296.80 / $296.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $416.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $238.37 / $290.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.66 / $458.66 / $458.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.97 / $343.84 / $343.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.41 / $282.61 / $649.91