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Maryland 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
$123.26 / $143.02 / $235.43
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.00 / $161.00 / $161.00
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 / $137.38 / $188.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.82 / $301.17 / $433.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.34 / $150.25 / $239.50
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.44 / $180.44 / $210.82