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Nebraska rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $339 · 10th–90th $148–$1,5850%10%20%10th90th$339Professionalmedian $204 · 10th–90th $107–$8710%10%20%10th90th$204$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
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $204.17 / $1,737.80
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $309.03 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $354.81 / $575.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $363.08 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $323.59
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $870.96
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $812.83 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $177.83 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $162.18 / $239.88