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West 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
$240.28 / $240.28 / $240.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.99 / $229.97 / $275.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.32 / $627.89 / $813.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.32 / $325.57 / $558.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $622.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $290.63 / $2,607.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.48 / $244.67 / $386.73