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Massachusetts rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $234 · 10th–90th $174$1,2020%20%10th90th$234Professionalmedian $209 · 10th–90th $138$3890%20%10th90th$209$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $173.78 / $269.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $1,621.81
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $309.03 / $407.38
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $234.42 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $239.88
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $524.81
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $1,621.81
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $309.03 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $194.98 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $239.88 / $354.81