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Replacement Nonmolded Calf Lacer

Kentucky rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $166 · 10th–90th $135$4680%20%10th90th$166Professionalmedian $162 · 10th–90th $138$1860%50%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
$154.88
Median
$154.88
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$162.18
Typical High
$177.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$309.03
Typical High
$323.59
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$177.83
Typical High
$181.97
CareSource
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$407.38
Typical High
$524.81
CareSource
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$478.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$467.74
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$239.88
Typical High
$1,659.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$229.09