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Minnesota rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.26 / $344.26 / $344.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.56 / $344.26 / $344.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.43 / $495.46 / $689.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.37 / $470.69 / $495.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $1,529.06 / $4,246.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.50 / $608.97 / $729.62
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.79 / $1,467.06 / $3,343.98
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.50 / $574.50 / $591.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.29 / $495.46 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $236.87 / $577.47
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 / $236.87 / $497.55