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West Virginia rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Facilitymedian $155 · 10th–90th $155–$5370%50%90th$155Professionalmedian $148 · 10th–90th $123–$2140%50%10th90th$148$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $147.91 / $158.49
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $407.38
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $537.03 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $1,621.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $199.53 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $251.19