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Replacement Nonmolded Calf Lacer

Montana rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated October 2026.

How much does Replacement Nonmolded Calf Lacer cost?

$316

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $316 for this service. The price depends on where it is billed: about $288 from a physician practice, and about $316 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$288$151 to $316
FacilityA hospital or hospital-owned outpatient department$316$309 to $17,378

How much rates vary

Facilitymedian $316 · 10th to 90th $209 to $17,783Professionalmedian $288 · 10th to 90th $79 to $339
$100$500$2K$10Kfacility $316professional $288

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$158.49
Typical High
$281.84
Cigna
Setting
Facility
Modifier
None
Typical Low
$208.93
Median
$316.23
Typical High
$316.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$316.23
Typical High
$316.23
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$380.19
Typical High
$18,197.01
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$338.84
Typical High
$18,620.87
Providence
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$316.23
Typical High
$316.23
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$239.88
Typical High
$316.23
United
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$151.36
Typical High
$251.19

Where Montana sits

The same service costs 5.0 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 3rd of 51

$316

HI $692DE $138

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.