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Replacement Nonmolded Calf Lacer

New Jersey rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $102$3090%20%40%10th90th$112Professionalmedian $158 · 10th–90th $117$3020%10%10th90th$158$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
$102.33
Median
$102.33
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$141.25
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$186.21
Typical High
$309.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$295.12
Typical High
$398.11
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$263.03
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$302.00