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California rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.33 / $279.33 / $1,789.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.85 / $279.33 / $1,789.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.13 / $873.89 / $1,968.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.70 / $283.29 / $460.78
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $734.20 / $1,311.06
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $822.81 / $1,916.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.05 / $290.63 / $331.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $299.35
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.49 / $397.79 / $682.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.08 / $434.09 / $942.60
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,138.50 / $2,945.62 / $2,945.62
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,350.60 / $4,455.00 / $4,650.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.45 / $953.45 / $953.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $524.97 / $629.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $533.37
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.48 / $1,170.48 / $1,170.48
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.49 / $496.10 / $497.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.69 / $232.04 / $563.48