Ankle-foot orthosis, pre-fabricated gauntlet style

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Form Fit Ankle W/Speedlace

Payers reporting HCPCS L1902

Payer pricing summary

Low

Average

$99

Median

$90

High

$324

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +27 other terms	425	$104	$110	$52	48%	—	$1 – $502
2	Aetna fee schedule · outpatient · +26 other terms	395	$105	$141	$106	75%	—	$1 – $752
3	Humana fee schedule · outpatient · +24 other terms	341	$98	$152	$187	123%	—	$1 – $941
4	Blue Cross Blue Shield fee schedule · outpatient · +25 other terms	264	$120	$145	$67	47%	—	$0 – $898
5	WellCare fee schedule · outpatient · +15 other terms	219	$116	$116	$27	23%	—	$16 – $234
6	Devoted fee schedule · outpatient · +9 other terms	162	$94	$113	$14	13%	—	$88 – $131
7	Molina fee schedule · outpatient · +18 other terms	157	$133	$130	$62	48%	—	$1 – $637
8	Cigna fee schedule · outpatient · +23 other terms	126	$105	$132	$74	56%	—	$19 – $432
9	Cigna Healthspring fee schedule · outpatient · +4 other terms	116	$101	$115	$11	10%	—	$92 – $126
10	Anthem fee schedule · outpatient · +21 other terms	100	$92	$119	$128	108%	—	$10 – $688
11	Kaiser fee schedule · outpatient · +19 other terms	85	$96	$285	$212	74%	—	$15 – $826
12	Ambetter facility · fee schedule · outpatient · +16 other terms	57	$160	$164	$42	26%	—	$43 – $236
13	Caresource fee schedule · outpatient · +14 other terms	55	$94	$84	$34	41%	—	$1 – $233
14	Clover fee schedule · outpatient · +4 other terms	42	$118	$112	$12	11%	—	$94 – $128
15	Superior Healthplan fee schedule · outpatient · +3 other terms	41	$128	$127	$11	9%	—	$14 – $128
16	Oscar fee schedule · outpatient · +12 other terms	36	$120	$124	$26	21%	—	$99 – $179
17	MultiPlan fee schedule · outpatient · +17 other terms	33	$162	$179	$140	78%	—	$36 – $524
18	Optum fee schedule · outpatient · +12 other terms	32	$95	$147	$79	54%	—	$67 – $306
19	Tricare facility · fee schedule · outpatient · +13 other terms	32	$105	$609	$3.5k	581%	—	$17 – $24.3k
20	Highmark facility · fee schedule · outpatient · +12 other terms	29	$207	$309	$187	61%	—	$42 – $879
21	Medica facility · fee schedule · outpatient · +14 other terms	27	$90	$74	$34	46%	—	$4 – $161
22	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$171	$108	$51	47%	—	$40 – $184
23	Medicare fee schedule · outpatient · +8 other terms	23	$88	$89	$2	2%	—	$88 – $93
24	Amerihealth Caritas fee schedule · outpatient · +8 other terms	19	$113	$108	$16	15%	—	$40 – $113
25	Bcbs Tx fee schedule · outpatient · +1 other terms	18	$120	$120	—	—	—	$120 – $120

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