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New Jersey rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $126 · 10th–90th $102–$3090%20%40%10th90th$126Professionalmedian $158 · 10th–90th $117–$3020%10%10th90th$158$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $186.21 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $295.12 / $416.87
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $173.78 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $295.12