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Texas rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $363 · 10th–90th $209$1,8200%10%10th90th$363Professionalmedian $229 · 10th–90th $195$3720%50%10th90th$229$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$208.93 / $208.93 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $229.09 / $346.74
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $478.63 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $2,570.40
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,677.35 / $4,677.35
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $371.54 / $691.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $229.09 / $489.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $234.42 / $234.42
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $354.81 / $691.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $331.13 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $281.84 / $331.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $478.63 / $478.63