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Replacement Nonmolded Calf Lacer

Mississippi rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $234 · 10th–90th $166$4070%20%40%10th90th$234Professionalmedian $178 · 10th–90th $138$2820%10%10th90th$178$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
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
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
$138.04
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$245.47
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$144.54
Typical High
$223.87