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Oregon rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.57 / $336.15 / $1,789.24
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 / $290.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.26 / $985.06 / $1,284.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.15 / $460.53 / $560.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.66 / $526.75 / $588.39
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.81 / $504.33 / $560.37
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.81 / $511.61 / $560.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $477.68 / $588.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $490.68 / $616.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.87 / $931.88 / $1,965.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.92 / $616.41 / $616.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.42 / $232.04 / $444.74