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Florida rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.70 / $213.56 / $244.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.70 / $229.97 / $407.26
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 / $299.35
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.72 / $326.85 / $465.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.62 / $171.73 / $188.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.23 / $232.04 / $332.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.73 / $171.73 / $278.64