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Nebraska rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.79 / $334.79 / $334.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.79 / $334.79 / $434.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.39 / $507.54 / $512.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $577.47 / $577.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.63 / $577.47 / $890.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.01 / $574.63 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.78 / $261.91 / $436.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.78 / $577.47 / $727.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.00 / $682.46 / $1,189.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.78 / $261.91 / $349.18