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Montana rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $457 · 10th–90th $302–$5620%20%40%10th90th$457Professionalmedian $339 · 10th–90th $209–$5620%10%10th90th$339$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $257.04 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $489.78 / $489.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $457.09 / $891.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $457.09 / $891.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $446.68 / $630.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $363.08 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $288.40 / $302.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $234.42 / $354.81