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North Carolina 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
$263.72 / $263.72 / $454.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.58 / $263.72 / $263.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.46 / $289.76 / $550.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.67 / $225.88 / $225.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.29 / $188.19 / $188.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $349.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $263.72 / $342.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.00 / $169.00 / $204.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.40 / $361.40 / $555.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.44 / $150.25 / $226.33
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.66 / $1,907.41 / $1,907.41
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,831.45 / $2,831.45 / $2,831.45