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Vermont rates for HCPCS L4055

Replace Non-Molded Calf Lacer For Custom Fabricated Orthosis Only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.96 / $195.96 / $226.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $295.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $200.62
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.19 / $188.19 / $295.14
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.38 / $188.19 / $200.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.56 / $214.65 / $464.22