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New Hampshire rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $575 · 10th–90th $316–$6920%20%40%10th90th$575Professionalmedian $380 · 10th–90th $245–$5250%20%10th90th$380$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $316.23 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $616.60 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $912.01
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $338.84 / $501.19
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $812.83