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Pennsylvania rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $631 · 10th–90th $191–$7410%20%40%10th90th$631Professionalmedian $245 · 10th–90th $191–$4070%20%40%10th90th$245$0.5$5.0$50.0$500.0$5.0K$50.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $245.47 / $389.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $380.19 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $831.76 / $1,202.26
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $331.13 / $478.63
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $245.47 / $389.05
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $851.14 / $1,230.27
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $446.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $630.96 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $234.42 / $501.19