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Replacement Nonmolded Calf Lacer

Colorado rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $240 · 10th–90th $98$4170%20%10th90th$240Professionalmedian $170 · 10th–90th $132$2290%20%40%10th90th$170$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
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$169.82
Typical High
$229.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$371.54
Typical High
$660.69
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$181.97
Typical High
$288.40
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
$316.23
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$239.88
Typical High
$416.87
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$309.03
Typical High
$794.33
Select Health
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$562.34
Typical High
$645.65
Select Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$309.03
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$151.36
Typical High
$223.87