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South 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
$149.06 / $149.06 / $149.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.02 / $149.06 / $263.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $220.63 / $319.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.13 / $188.19 / $207.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $181.11 / $188.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.02 / $216.00 / $472.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.00 / $169.00 / $182.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.51 / $203.51 / $203.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $148.91 / $202.56