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Montana rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $295 · 10th–90th $195–$3720%20%40%10th90th$295Professionalmedian $182 · 10th–90th $138–$3720%10%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $169.82 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $316.23 / $316.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $295.12 / $575.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $295.12 / $575.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $281.84 / $407.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $239.88 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $186.21 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $229.09