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Wisconsin rates for HCPCS L4050

Replace molded calf lacer, for custom fabricated orthosis only

Facilitymedian $501 · 10th–90th $437$9120%50%10th90th$501Professionalmedian $347 · 10th–90th $219$7590%10%20%10th90th$347$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
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $251.19 / $380.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $831.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $467.74 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $1,174.90 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $724.44 / $954.99
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $407.38 / $630.96
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $501.19 / $616.60
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $501.19 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $269.15 / $575.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $218.78
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $575.44 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $758.58 / $1,445.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $1,000.00 / $2,951.21
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $426.58 / $4,466.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $275.42 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $245.47 / $426.58