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Rhode Island 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 / $279.33 / $335.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.92 / $1,081.75 / $1,280.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.05 / $297.70 / $497.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $327.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $290.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.69 / $282.61 / $471.02