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Kentucky 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
$109.47 / $154.80 / $160.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.99 / $154.80 / $167.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.48 / $301.17 / $316.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.86 / $176.37 / $183.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.88 / $421.64 / $496.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.17 / $376.46 / $496.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $1,628.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.39 / $191.94 / $239.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $150.25 / $229.92