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Mississippi 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
$168.78 / $168.78 / $268.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.43 / $192.52 / $268.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.38 / $233.38 / $233.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.38 / $233.38 / $233.38
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $142.97 / $231.53