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Connecticut 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
$195.17 / $195.17 / $195.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.07 / $143.02 / $195.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.20 / $401.56 / $459.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.43 / $183.43 / $192.20
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 / $188.19
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.01 / $261.01 / $261.01
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.76 / $261.01 / $331.29
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.34 / $191.34 / $191.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.25 / $196.80 / $333.89