go back

Replacement Nonmolded Calf Lacer

New York rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $191 · 10th–90th $132$4680%20%10th90th$191Professionalmedian $182 · 10th–90th $126$4570%20%10th90th$182$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$144.54
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$151.36
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$616.60
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$524.81
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$251.19
Typical High
$251.19
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$208.93
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$501.19
Typical High
$1,174.90
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$323.59
Typical High
$588.84
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$194.98
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$186.21
Typical High
$190.55
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$295.12
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$199.53
Typical High
$489.78
Univera
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$186.21
Typical High
$194.98
Univera
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$186.21
Typical High
$190.55