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Louisiana rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.37 / $266.83 / $359.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.97 / $266.83 / $290.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.83 / $691.59 / $972.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.08 / $330.22 / $330.22
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $280.35 / $290.63
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 / $220.81 / $355.08