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Tennessee rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $229 · 10th–90th $148–$1,6220%20%10th90th$229Professionalmedian $148 · 10th–90th $132–$2630%50%10th90th$148$0.2$1.0$5.0$20.0$100.0$500.0$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
$134.90 / $147.91 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $147.91 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $208.93