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Michigan rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.95 / $282.95 / $282.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.67 / $282.95 / $282.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.91 / $1,494.11 / $2,721.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.69 / $495.46 / $668.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.32 / $302.32 / $322.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.37 / $396.37 / $396.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $290.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.35 / $290.63 / $411.98
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.95 / $358.06 / $358.06
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.35 / $358.06 / $520.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.64 / $366.64 / $421.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.68 / $232.68 / $354.62