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North Carolina rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $263 · 10th–90th $132–$7240%20%10th90th$263Professionalmedian $204 · 10th–90th $132–$2630%20%10th90th$204$0.2$2.0$20.0$200.0$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
$263.03 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $190.55 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $229.09
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $154.88 / $199.53
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $263.03 / $446.68
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $151.36 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $151.36 / $223.87
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38