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Replacement Nonmolded Calf Lacer

North Dakota rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $219 · 10th–90th $209$4470%50%10th90th$219Professionalmedian $282 · 10th–90th $182$3630%20%10th90th$282$100.0$200.0$500.0$1.0K$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
$208.93
Median
$218.78
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$208.93
Typical High
$1,548.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$363.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$346.74
Typical High
$436.52
Medica
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$295.12
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$354.81