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Kansas rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.72 / $434.72 / $434.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.80 / $284.82 / $434.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.20 / $390.81 / $414.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.91 / $387.91 / $387.91
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 / $290.63 / $718.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $423.09 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $261.91 / $670.68
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 / $257.61 / $350.77