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Louisiana rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.82 / $176.02 / $237.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.91 / $176.02 / $191.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.04 / $456.20 / $641.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.11 / $217.83 / $217.83
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $170.41 / $188.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $145.65 / $229.92