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Mississippi rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.64 / $260.64 / $415.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.94 / $297.30 / $415.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.42 / $360.42 / $360.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.42 / $360.42 / $360.42
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $220.81 / $367.02