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Arizona rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $331 · 10th–90th $105–$8910%10%10th90th$331Professionalmedian $158 · 10th–90th $132–$3310%20%10th90th$158$0.2$1.0$5.0$20.0$100.0$500.0$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
$131.83 / $162.18 / $269.15
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $436.52 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $398.11 / $776.25
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 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $269.15 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $2,754.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $263.03 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $223.87