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Delaware rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $186 · 10th–90th $0–$2630%50%10th90th$186Professionalmedian $148 · 10th–90th $123–$7940%20%10th90th$148$0.2$1.0$5.0$20.0$100.0$500.0

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
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $147.91 / $794.33
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
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.24 / $194.98 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $229.09