go back

Oregon rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $295 · 10th–90th $229–$3090%50%10th90th$295Professionalmedian $182 · 10th–90th $135–$3470%10%10th90th$182$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $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 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $660.69 / $812.83
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $323.59
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $245.47 / $346.74
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $309.03
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $309.03 / $338.84
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $263.03 / $389.05
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $269.15 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $489.78 / $1,202.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $346.74 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $199.53 / $489.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $288.40