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Missouri rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $427 · 10th–90th $257–$1,1750%20%10th90th$427Professionalmedian $275 · 10th–90th $209–$4470%20%10th90th$275$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $269.15 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $1,862.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $281.84 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $416.87 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $426.58 / $426.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $251.19 / $407.38