Custom-made ankle brace

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

Afo molded ankle gauntlet

Payers reporting HCPCS L1904

Payer pricing summary

Low

$187

Average

$683

Median

$606

High

$1.2k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +15 other terms	361	$551	$662	$372	56%	—	$269 – $5.0k
2	UnitedHealthcare fee schedule · outpatient · +15 other terms	360	$546	$572	$144	25%	—	$1 – $1.8k
3	Humana fee schedule · outpatient · +16 other terms	319	$540	$827	$872	105%	—	$285 – $4.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	220	$551	$760	$444	58%	—	$0 – $3.0k
5	WellCare fee schedule · outpatient · +6 other terms	208	$557	$579	$98	17%	—	$530 – $1.1k
6	Devoted fee schedule · outpatient · +3 other terms	165	$540	$544	$18	3%	—	$519 – $735
7	Molina fee schedule · outpatient · +7 other terms	140	$786	$755	$282	37%	—	$293 – $1.4k
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$556	$558	$38	7%	—	$540 – $742
9	Cigna fee schedule · outpatient · +13 other terms	104	$557	$643	$209	32%	—	$359 – $1.6k
10	Anthem fee schedule · outpatient · +8 other terms	80	$540	$782	$731	93%	—	$301 – $4.2k
11	Kaiser fee schedule · outpatient · +5 other terms	64	$551	$923	$648	70%	—	$519 – $4.0k
12	Ambetter facility · fee schedule · outpatient · +7 other terms	46	$999	$1.0k	$194	19%	—	$530 – $1.5k
13	Superior Healthplan fee schedule · outpatient	40	$567	$567	$3	0%	—	$530 – $567
14	Clover fee schedule · outpatient · +3 other terms	37	$559	$561	$27	5%	—	$540 – $720
15	Oscar fee schedule · outpatient · +7 other terms	36	$567	$663	$220	33%	—	$530 – $1.2k
16	Optum fee schedule · outpatient · +4 other terms	33	$540	$717	$281	39%	—	$519 – $1.4k
17	Caresource fee schedule · outpatient · +5 other terms	29	$540	$567	$176	31%	—	$295 – $857
18	Medica facility · fee schedule · outpatient · +6 other terms	22	$567	$519	$134	26%	—	$185 – $905
19	Regence facility · fee schedule · outpatient · +4 other terms	19	$562	$544	$36	7%	—	$450 – $573
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$648	$644	$13	2%	—	$616 – $657
21	Bcbs Tx fee schedule · outpatient	18	$530	$530	—	—	—	$530 – $530
22	Medicare fee schedule · outpatient · +3 other terms	18	$519	$521	$4	1%	—	$519 – $530
23	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$555	$642	$159	25%	—	$302 – $876
24	Tricare facility · fee schedule · outpatient · +4 other terms	15	$632	$593	$53	9%	—	$503 – $644
25	Highmark facility · fee schedule · outpatient · +4 other terms	14	$1.1k	$1.1k	$451	42%	—	$559 – $1.8k

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