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Alaska rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.07 / $848.07 / $848.07
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 / $299.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $149.80 / $149.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.35 / $940.50 / $1,485.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $149.80 / $290.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $299.35 / $590.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.66 / $740.84 / $1,234.74