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Arkansas rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.53 / $170.53 / $170.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.78 / $170.53 / $170.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.85 / $350.54 / $389.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.17 / $301.17 / $301.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.17 / $301.17 / $301.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $245.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $239.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $146.22 / $202.56