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New Mexico rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.07 / $228.07 / $228.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.07 / $350.24 / $1,789.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.66 / $371.54 / $442.69
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 / $290.63 / $290.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.08 / $465.10 / $697.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $149.80 / $349.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $586.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.69 / $232.04 / $349.53