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Missouri rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $263 · 10th–90th $170–$7240%20%10th90th$263Professionalmedian $174 · 10th–90th $138–$2820%20%40%10th90th$174$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
$169.82 / $169.82 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $165.96 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $181.97 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $257.04 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $2,754.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $263.03 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $154.88 / $245.47