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Utah rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $288 · 10th–90th $148–$4680%20%40%10th90th$288Professionalmedian $331 · 10th–90th $148–$2,6920%10%10th90th$331$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $281.84 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $288.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $338.84 / $436.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $467.74 / $467.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $524.81
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $575.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $478.63 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $234.42 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $234.42 / $371.54