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New Hampshire rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $407 · 10th–90th $224–$4900%20%40%10th90th$407Professionalmedian $245 · 10th–90th $148–$3800%20%10th90th$245$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
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $194.98 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $436.52 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $229.09 / $354.81
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $575.44