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Replacement Nonmolded Calf Lacer

Nationwide rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $240 · 10th–90th $138$7940%20%10th90th$240Professionalmedian $182 · 10th–90th $129$3550%20%10th90th$182$0.2$2.0$20.0$200.0$2.0K$20.0K$200.0K

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
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$162.18
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$162.18
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$190.55
Typical High
$707.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$181.97
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$1,148.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$213.80
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$323.59