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Florida rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.78 / $138.28 / $158.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.26 / $148.91 / $263.72
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 / $190.64
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.44 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.80 / $211.64 / $301.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.90 / $166.01 / $182.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.34 / $150.25 / $215.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.01 / $166.01 / $180.44