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Replacement Nonmolded Calf Lacer

Minnesota rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $525 · 10th–90th $257$2,4550%20%10th90th$525Professionalmedian $302 · 10th–90th $200$3470%20%40%10th90th$302$0.5$2.0$10.0$50.0$200.0$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
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$218.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$302.00
Typical High
$446.68
BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$302.00
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,148.15
Typical High
$3,090.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$398.11
Typical High
$446.68
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,258.93
Typical High
$2,454.71
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$478.63
Medica
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$302.00
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$2.40
Median
$151.36
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$177.83
Typical High
$426.58