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Replacement Nonmolded Calf Lacer

Maine rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $417 · 10th–90th $186$5130%20%10th90th$417Professionalmedian $224 · 10th–90th $141$3550%20%10th90th$224$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$181.97
Typical High
$245.47
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$478.63
Typical High
$549.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$416.87
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$181.97
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$186.21
Typical High
$263.03
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$331.13
Typical High
$354.81