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Wisconsin rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $309 · 10th–90th $263$5620%20%40%10th90th$309Professionalmedian $209 · 10th–90th $145$4570%20%10th90th$209$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
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $154.88 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $707.95 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $436.52 / $575.44
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $245.47 / $380.19
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $302.00 / $398.11
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $302.00 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $173.78 / $354.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $199.53
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $346.74 / $602.56
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $478.63 / $954.99
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $616.60 / $1,905.46
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $275.42 / $2,818.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $177.83 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $151.36 / $257.04