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Alabama rates for HCPCS L4055

Replace Non-Molded Calf Lacer For Custom Fabricated Orthosis Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.63 / $271.63 / $271.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.58 / $271.63 / $271.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.16 / $224.16 / $224.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $301.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $263.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $150.25 / $226.33