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Replacement Nonmolded Calf Lacer

Georgia rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $309 · 10th–90th $145$1,1220%20%10th90th$309Professionalmedian $182 · 10th–90th $141$2950%20%10th90th$182$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
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$154.88
Typical High
$263.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$724.44
Typical High
$1,122.02
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$407.38
CareSource
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
CareSource
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
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
$371.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$309.03
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$295.12