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Replacement Nonmolded Calf Lacer

South Carolina rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $148$4070%20%10th90th$186Professionalmedian $158 · 10th–90th $132$2630%20%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
$147.91
Median
$147.91
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$275.42
Typical High
$309.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$263.03
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$346.74
Medcost
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$181.97
Medcost
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$229.09
Typical High
$501.19
Medcost
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$97.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$194.98
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$208.93