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Hawaii rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $186 · 10th–90th $148–$5370%50%10th90th$186Professionalmedian $182 · 10th–90th $132–$7240%10%10th90th$182$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
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $158.49 / $208.93
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
$186.21 / $630.96 / $851.14
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $724.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $691.83 / $794.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $186.21 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $229.09 / $741.31