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Washington, DC 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
$123.26 / $123.26 / $123.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.26 / $123.26 / $123.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.00 / $161.00 / $161.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $137.38 / $137.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.76 / $195.76 / $597.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $150.25 / $225.75