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North Dakota rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $219 · 10th–90th $209–$4900%50%10th90th$219Professionalmedian $209 · 10th–90th $145–$3470%10%10th90th$209$100.0$200.0$500.0$1.0K$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 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $181.97 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $331.13 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $346.74 / $436.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $295.12 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $489.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $208.93 / $354.81