go back

Nevada rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.13 / $137.13 / $158.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.26 / $137.13 / $160.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.56 / $401.56 / $401.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.43 / $183.43 / $401.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $295.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $265.39
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.30 / $321.25 / $522.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.64 / $150.25 / $250.42