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Replacement Nonmolded Calf Lacer

Texas rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $229 · 10th–90th $138$1,1480%10%10th90th$229Professionalmedian $151 · 10th–90th $129$2450%50%10th90th$151$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
$138.04
Median
$141.25
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$144.54
Typical High
$213.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$316.23
Typical High
$316.23
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
$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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$239.88
Typical High
$407.38
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$295.12
Typical High
$316.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$154.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$229.09
Typical High
$416.87
Providence
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
United
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$251.19
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$213.80
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$316.23
Typical High
$426.58