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Replacement Nonmolded Calf Lacer

Iowa rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $257 · 10th–90th $148$8510%20%10th90th$257Professionalmedian $204 · 10th–90th $123$4370%10%20%10th90th$204$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
$141.25
Median
$208.93
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$346.74
Typical High
$436.52
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$501.19
Typical High
$549.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$398.11
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$194.98
Typical High
$537.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$380.19
Typical High
$467.74
Midlands
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Midlands
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$537.03
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$263.03
Typical High
$645.65
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$162.18
Typical High
$309.03
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$309.03
Typical High
$309.03