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Rhode Island rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $275.42 / $870.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $295.12 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $467.74