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North Dakota rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.12 / $219.12 / $219.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.26 / $209.26 / $219.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.60 / $332.95 / $341.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.13 / $352.62 / $443.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.38 / $219.12 / $1,580.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.99 / $150.25 / $250.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.64 / $166.81 / $357.45