go back

Missouri rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.82 / $274.82 / $366.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.66 / $284.82 / $434.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.97 / $551.22 / $2,423.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.18 / $283.29 / $424.73
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 / $212.16 / $299.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.37 / $423.09 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.24 / $261.91 / $638.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.24 / $261.91 / $379.53