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Minnesota rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $339 · 10th–90th $224–$2,1880%20%10th90th$339Professionalmedian $302 · 10th–90th $155–$3470%50%10th90th$302$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
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $181.97 / $239.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $302.00 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $302.00 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,122.02 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $389.05 / $446.68
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $1,122.02 / $2,187.76
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $478.63
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $302.00 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $151.36 / $363.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.40 / $147.91 / $489.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $177.83 / $426.58