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Replacement Nonmolded Calf Lacer

New Mexico rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $219 · 10th–90th $98$3630%10%10th90th$219Professionalmedian $182 · 10th–90th $141$5130%10%10th90th$182$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
$151.36
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$181.97
Typical High
$1,737.80
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
$446.68
Molina
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$309.03
Typical High
$457.09
Providence
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$223.87
Typical High
$363.08
Providence
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$165.96
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$151.36
Typical High
$223.87