go back

South Carolina rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $195 · 10th–90th $148–$4270%10%20%10th90th$195Professionalmedian $158 · 10th–90th $132–$2690%20%10th90th$158$50.0$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
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $158.49 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $302.00 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $186.21 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $346.74
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $181.97
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $229.09 / $501.19
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $97.72
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $204.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $190.55 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $151.36 / $204.17