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Colorado rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.66 / $168.66 / $168.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.07 / $168.66 / $231.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.17 / $338.39 / $614.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.43 / $183.43 / $198.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $188.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $137.38 / $316.23
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $168.66 / $376.46
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.00 / $97.00 / $97.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.85 / $376.46 / $602.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.43 / $150.25 / $226.33