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Wyoming rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.45 / $260.45 / $407.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.20 / $454.20 / $454.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.20 / $454.20 / $454.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $577.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $290.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.72 / $232.04 / $257.61