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Iowa rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $513 · 10th–90th $288–$1,4130%20%10th90th$513Professionalmedian $282 · 10th–90th $200–$5620%10%20%10th90th$282$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $269.15 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $575.44 / $724.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $794.33 / $870.96
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $616.60 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $316.23 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $602.56 / $707.95
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $870.96 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $537.03 / $1,230.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $263.03 / $501.19
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $501.19 / $501.19