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Replacement Nonmolded Calf Lacer

Oregon rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $295 · 10th–90th $234$3090%50%10th90th$295Professionalmedian $229 · 10th–90th $135$3470%10%20%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
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$208.93
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
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$660.69
Typical High
$812.83
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$229.09
Typical High
$323.59
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$245.47
Typical High
$346.74
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$295.12
Typical High
$309.03
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$309.03
Typical High
$338.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$263.03
Typical High
$389.05
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$269.15
Typical High
$323.59
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$316.23
Typical High
$1,202.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$0.24
Median
$165.96
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$288.40