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Replacement Nonmolded Calf Lacer

Maryland rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $174 · 10th–90th $112$3090%10%20%10th90th$174Professionalmedian $145 · 10th–90th $123$2570%20%10th90th$145$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Global
Typical Low
$123.03
Median
$131.83
Typical High
$245.47
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$309.03
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$239.88
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$263.03