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Oklahoma rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $170 · 10th–90th $141–$4470%20%40%10th90th$170Professionalmedian $151 · 10th–90th $135–$2140%10%20%10th90th$151$100.0$200.0$500.0$1.0K$2.0K

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
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $158.49 / $194.98
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 / $346.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $204.17 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $151.36 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $213.80 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $213.80