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Indiana rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.23 / $245.23 / $495.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.80 / $247.91 / $266.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.41 / $443.44 / $495.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.70 / $283.29 / $388.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.60 / $545.01 / $697.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.14 / $545.01 / $668.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $495.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $508.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $239.48 / $349.53