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Vermont rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.44 / $276.44 / $318.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $416.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $299.35
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $416.36
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $299.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.41 / $335.57 / $654.89