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Idaho rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.35 / $490.68 / $490.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $388.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $299.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $407.26 / $560.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.33 / $532.35 / $560.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $418.64 / $504.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.68 / $547.24 / $820.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.26 / $392.26 / $588.39
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 / $374.43