go back

Virginia rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $309 · 10th–90th $148$3890%20%40%10th90th$309Professionalmedian $182 · 10th–90th $132$2880%20%10th90th$182$0.2$2.0$20.0$200.0$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
$123.03 / $147.91 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $147.91 / $263.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $323.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $380.19
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $186.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $309.03 / $426.58
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $199.53 / $302.00
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $204.17 / $380.19
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $177.83 / $380.19
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $251.19 / $891.25
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $251.19 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $151.36 / $245.47