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Louisiana rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $263 · 10th–90th $174–$5500%20%10th90th$263Professionalmedian $162 · 10th–90th $126–$2340%20%10th90th$162$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
$177.83 / $177.83 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $165.96 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $457.09 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
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 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $251.19 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $144.54 / $213.80