go back

Arizona rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.20 / $248.05 / $407.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.81 / $588.14 / $1,063.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.02 / $542.69 / $739.41
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 / $212.16 / $574.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $414.36 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.51 / $232.04 / $349.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.72 / $232.04 / $349.53