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Connecticut rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $195 · 10th–90th $186–$3800%50%10th90th$195Professionalmedian $174 · 10th–90th $129–$2690%10%20%10th90th$174$100.0$200.0$500.0$1.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $162.18 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $407.38 / $489.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $190.55 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
ConnectiCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $363.08
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $281.84 / $398.11
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $173.78 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $190.55 / $316.23