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Replacement Nonmolded Calf Lacer

Indiana rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $309 · 10th–90th $148$3550%20%40%10th90th$309Professionalmedian $162 · 10th–90th $138$2690%20%10th90th$162$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
$147.91
Median
$147.91
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$263.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$309.03
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$181.97
Typical High
$309.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$389.05
Typical High
$446.68
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
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$208.93
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$223.87