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Mississippi rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $162.18 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $239.88 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $144.54 / $223.87