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Iowa rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $309 · 10th–90th $186–$9120%20%10th90th$309Professionalmedian $174 · 10th–90th $123–$3470%10%20%10th90th$174$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
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $173.78 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $346.74 / $436.52
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $501.19 / $549.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $398.11 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $537.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $371.54 / $457.09
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $537.03 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $331.13 / $794.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $162.18 / $302.00
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $309.03