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Nationwide rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $240 · 10th–90th $138$7940%20%10th90th$240Professionalmedian $174 · 10th–90th $132$3310%20%10th90th$174$0.2$2.0$20.0$200.0$2.0K$20.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $158.49 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $186.21 / $741.31
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $181.97 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $199.53 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $309.03