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Replacement Nonmolded Calf Lacer

Florida rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $158 · 10th–90th $129$5620%20%40%10th90th$158Professionalmedian $155 · 10th–90th $126$2630%20%40%10th90th$155$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
$128.82
Median
$144.54
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$158.49
Typical High
$263.03
AvMed
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
AvMed
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$288.40
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$186.21
Typical High
$309.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$213.80
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$309.03