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Colorado rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.45 / $260.45 / $260.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.77 / $260.45 / $350.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.10 / $522.59 / $948.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.29 / $283.29 / $283.29
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 / $488.36
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $260.45 / $581.38
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.80 / $149.80 / $149.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.52 / $581.38 / $930.20
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 / $349.53