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Alaska rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $186 · 10th–90th $98–$6170%20%40%10th90th$186Professionalmedian $204 · 10th–90th $148–$7940%10%20%10th90th$204$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $181.97 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $741.31
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $295.12 / $616.60
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $616.60 / $954.99
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $616.60 / $645.65
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $616.60 / $645.65
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $426.58
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $186.21 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $316.23 / $1,584.89