go back

Rhode Island rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.45 / $180.89 / $238.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.75 / $766.82 / $907.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.94 / $262.27 / $363.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $232.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $188.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.43 / $200.33 / $333.89