go back

New York rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $234 · 10th–90th $132$5500%20%10th90th$234Professionalmedian $182 · 10th–90th $132$4570%20%10th90th$182$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$102.33 / $239.88 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $239.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $524.81
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $251.19 / $251.19
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $354.81
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $501.19 / $1,174.90
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $309.03 / $588.84
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $194.98
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $186.21 / $190.55
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $295.12 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $173.78 / $851.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $199.53 / $512.86
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $186.21 / $194.98
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $186.21 / $190.55