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Ohio rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $316 · 10th–90th $162–$5250%20%10th90th$316Professionalmedian $162 · 10th–90th $132–$2690%20%10th90th$162$0.2$1.0$5.0$20.0$100.0$500.0

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
$162.18 / $251.19 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $158.49 / $208.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $323.59 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $181.97 / $398.11
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $257.04 / $363.08
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $269.15 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $181.97 / $263.03
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $346.74 / $630.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $245.47 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $151.36 / $223.87