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Washington rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $562 · 10th–90th $363–$1,2300%20%10th90th$562Professionalmedian $380 · 10th–90th $214–$7590%20%10th90th$380$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $281.84 / $489.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $549.54 / $549.54
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $630.96
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $691.83 / $1,584.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $660.69 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $389.05 / $467.74
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $549.54 / $562.34
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $562.34 / $575.44
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $812.83 / $1,122.02
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $549.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $630.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $630.96 / $758.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $269.15 / $446.68
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $398.11 / $851.14