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Oklahoma rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.92 / $219.92 / $324.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.78 / $219.92 / $247.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.26 / $407.26 / $407.26
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 / $290.63 / $290.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $288.33 / $2,531.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $232.04 / $460.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.69 / $229.97 / $332.89