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Oklahoma rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $257.04 / $407.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $575.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $309.03 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $234.42 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $446.68 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $223.87 / $331.13