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Virginia rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.36 / $229.97 / $229.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.36 / $229.97 / $279.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.10 / $465.10 / $493.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.29 / $283.29 / $356.06
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.00 / $249.00 / $317.94
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
$325.57 / $418.59 / $558.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.80 / $286.05 / $529.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.00 / $581.38 / $774.71
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.82 / $352.05 / $582.38
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.82 / $352.05 / $582.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.72 / $232.04 / $349.53