go back

Maine rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $417 · 10th–90th $186–$5130%20%10th90th$417Professionalmedian $182 · 10th–90th $138–$3550%10%20%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
$138.04 / $173.78 / $616.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $478.63 / $549.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $177.83 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $147.91 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $323.59 / $354.81