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Illinois rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $339 · 10th–90th $155–$1,5490%20%10th90th$339Professionalmedian $162 · 10th–90th $135–$3160%20%10th90th$162$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$154.88 / $154.88 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $158.49 / $269.15
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $588.84 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $346.74
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $457.09 / $645.65
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $245.47 / $489.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $251.19