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Iowa 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
$209.26 / $209.26 / $219.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.95 / $180.89 / $268.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $354.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.19 / $349.13 / $436.41
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.11 / $376.53 / $545.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.29 / $399.45 / $1,580.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.91 / $170.88 / $438.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.18 / $354.22 / $457.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.10 / $413.78 / $676.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.91 / $160.65 / $378.84
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.92 / $305.92 / $305.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.68 / $305.92 / $305.92