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Replacement Nonmolded Calf Lacer

Arizona rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $107$8910%10%10th90th$347Professionalmedian $162 · 10th–90th $126$4170%20%10th90th$162$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
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$162.18
Typical High
$204.17
BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$457.09
Typical High
$870.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$416.87
Typical High
$851.14
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
$186.21
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$269.15
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$2,754.23
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$331.13
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$223.87