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Replacement Nonmolded Calf Lacer

Alabama rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $112$3470%20%10th90th$186Professionalmedian $182 · 10th–90th $129$2820%20%10th90th$182$0.2$1.0$5.0$20.0$100.0$500.0

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
Professional
Modifier
Global
Typical Low
$138.04
Median
$204.17
Typical High
$281.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$190.55
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$144.54
Typical High
$229.09