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Replacement Nonmolded Calf Lacer

Vermont rates for HCPCS L4055

Replace nonmolded calf lacer, for custom fabricated orthosis only

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $112$2630%50%10th90th$186Professionalmedian $195 · 10th–90th $186$2290%50%10th90th$195$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$194.98
Typical High
$223.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$263.03
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$251.19
Typical High
$812.83