Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Replace non-molded calf lace
Arlington, TX
See all hospitals reporting HCPCS L4055 →Price type
AMH Cath Labs LLC’s median price of $329 is 2% above the median hospital's median price ($322), higher than 61% of the 812 hospitals reporting HCPCS L4055. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 8 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield medicare advantage case rate · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 2 | Humana medicare advantage case rate · outpatient | $325 | $325 | — | — | — | $325 – $325 |
| 3 | Humana medicare advantage ppo case rate · outpatient | $325 | $325 | — | — | — | $325 – $325 |
| 4 | Molina medicare advantage case rate · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 5 | WellCare medicare advantage hmo case rate · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 6 | WellCare medicare advantage mmp case rate · outpatient | $344 | $344 | — | — | — | $344 – $344 |
| 7 | UnitedHealthcare medicare advantage ppo case rate · outpatient | $347 | $347 | — | — | — | $347 – $347 |
| 8 | UnitedHealthcare medicare advantage hmo case rate · outpatient | $354 | $354 | — | — | — | $354 – $354 |
Last updated: Apr 21, 2026
See Replacement lacer for custom leg brace pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.