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Tennessee rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.25 / $209.25 / $228.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.38 / $220.88 / $391.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.12 / $418.59 / $418.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.62 / $290.63 / $290.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $290.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.20 / $2,531.55 / $2,945.62
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,350.60 / $4,455.00 / $4,650.97
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 / $227.19 / $349.53