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Idaho rates for HCPCS L4055

Replace Non-Molded Calf Lacer For Custom Fabricated Orthosis Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.22 / $267.52 / $267.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $251.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $200.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $229.37 / $305.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.98 / $290.25 / $305.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $228.25 / $274.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.52 / $298.37 / $447.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.87 / $213.87 / $320.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.91 / $150.25 / $226.33