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Kansas 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
$266.66 / $266.66 / $266.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.00 / $174.71 / $266.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.64 / $307.29 / $325.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.01 / $305.01 / $305.01
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 / $188.19 / $436.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $259.51 / $1,580.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $160.65 / $411.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $160.65 / $215.16