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Kentucky rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.06 / $239.05 / $247.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.38 / $245.23 / $266.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.52 / $465.10 / $488.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.54 / $272.36 / $283.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.83 / $655.79 / $792.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.85 / $581.38 / $767.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $622.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $2,607.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.06 / $296.42 / $370.52
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 / $232.04 / $372.08