go back

Replacement Nonmolded Calf Lacer

Tennessee rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $234 · 10th–90th $148$1,9500%20%10th90th$234Professionalmedian $148 · 10th–90th $132$2510%50%10th90th$148$0.2$1.0$5.0$20.0$100.0$500.0$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
Facility
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$144.54
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,818.38
Median
$2,818.38
Typical High
$2,818.38
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$213.80