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Replacement Nonmolded Calf Lacer

North Carolina rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $263 · 10th–90th $135$6030%20%10th90th$263Professionalmedian $229 · 10th–90th $135$2630%20%40%10th90th$229$0.2$2.0$20.0$200.0$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
$263.03
Median
$263.03
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$263.03
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$295.12
Typical High
$602.56
BCBS
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$208.93
Medcost
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$154.88
Typical High
$199.53
Medcost
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$263.03
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$245.47
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$223.87
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,818.38
Median
$2,818.38
Typical High
$2,818.38