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Illinois rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $562 · 10th–90th $251–$2,5700%20%10th90th$562Professionalmedian $257 · 10th–90th $209–$5010%20%10th90th$257$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
$251.19 / $251.19 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $251.19 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $954.99 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $575.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $724.44 / $1,023.29
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $398.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $407.38 / $758.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $245.47 / $416.87