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New Mexico rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $219 · 10th–90th $98–$3630%10%10th90th$219Professionalmedian $158 · 10th–90th $138–$2690%20%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $158.49 / $229.09
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
$138.04 / $138.04 / $371.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $309.03 / $457.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $223.87 / $363.08
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $323.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $223.87