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 lacer, for custom fabricated orthosis only
Argyle, TX
See all hospitals reporting HCPCS L4055 →Price type
Medical City Argyle’s median price of $329 is 2% above the median hospital's median price ($322), higher than 61% of the 816 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: 9 payers, 25 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 | Humana tricare fee schedule · outpatient | $304 | $304 | — | — | — | $304 – $304 |
| 2 | Blue Cross Blue Shield mcrppo fee schedule · outpatient | $307 | $307 | — | — | — | $307 – $307 |
| 3 | Blue Cross Blue Shield mgmcrhmo fee schedule · outpatient | $307 | $307 | — | — | — | $307 – $307 |
| 4 | Devoted hmo fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 5 | Devoted mcr fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 6 | Devoted mme fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 7 | Devoted pos fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 8 | Devoted ppo fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 9 | Devoted snp fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 10 | Humana mgmcr fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 11 | UnitedHealthcare mgmcr fee schedule · outpatient | $315 | $315 | — | — | — | $315 – $315 |
| 12 | Aetna mcr fee schedule · outpatient | $316 | $316 | — | — | — | $316 – $316 |
| 13 | Cigna Healthspring mgmcr fee schedule · outpatient | $319 | $319 | — | — | — | $319 – $319 |
| 14 | WellCare mgmcr fee schedule · outpatient | $322 | $322 | — | — | — | $322 – $322 |
| 15 | Superior Healthplan mgmcrdualeligible fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 16 | Superior Healthplan mgmcrhmo fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 17 | Superior Healthplan mgmcrpffs fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 18 | Superior Healthplan mgmcrpos fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 19 | Superior Healthplan mgmcrppo fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 20 | Superior Healthplan mgmcrsnp fee schedule · outpatient | $329 | $329 | — | — | — | $329 – $329 |
| 21 | Molina mcr fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 22 | Molina mme fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 23 | Molina mmp fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 24 | Molina hix fee schedule · outpatient | $820 | $820 | — | — | — | $820 – $820 |
| 25 | Humana comm fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
Last updated: Mar 1, 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.