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Florida rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $145 · 10th–90th $129–$2450%50%10th90th$145Professionalmedian $158 · 10th–90th $126–$2630%20%40%10th90th$158$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $138.04 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $158.49 / $263.03
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $288.40 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Florida Blue
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $147.91
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $186.21 / $309.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $165.96 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $213.80
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $309.03