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Replacement Nonmolded Calf Lacer

Michigan rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $407 · 10th–90th $174$1,2020%20%10th90th$407Professionalmedian $182 · 10th–90th $145$3020%20%10th90th$182$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
$173.78
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$208.93
BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$912.01
Typical High
$1,737.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$302.00
Typical High
$316.23
CareSource
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$169.82
Typical High
$186.21
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$575.44
Typical High
$645.65
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$239.88
Typical High
$371.54
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$245.47
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$229.09