Semi-rigid prefabricated ankle-foot brace for tibial fracture

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

HC AFO TIBIAL FX ORTHOSIS SEMI-RIGID PREFAB

Payers reporting HCPCS L2114

Payer pricing summary

Low

$112

Average

$825

Median

$772

High

$2.2k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +20 other terms	391	$730	$750	$393	52%	—	$1 – $3.1k
2	Aetna fee schedule · outpatient · +18 other terms	375	$753	$875	$580	66%	—	$33 – $5.7k
3	Humana fee schedule · outpatient · +16 other terms	322	$723	$1.1k	$1.2k	111%	—	$29 – $5.8k
4	Blue Cross Blue Shield fee schedule · outpatient · +21 other terms	228	$739	$935	$538	58%	—	$0 – $4.0k
5	WellCare fee schedule · outpatient · +10 other terms	211	$739	$782	$185	24%	—	$236 – $1.7k
6	Devoted fee schedule · outpatient · +8 other terms	165	$672	$727	$45	6%	—	$646 – $907
7	Molina fee schedule · outpatient · +11 other terms	146	$982	$1.0k	$406	41%	—	$27 – $2.0k
8	Cigna fee schedule · outpatient · +17 other terms	119	$719	$930	$680	73%	—	$74 – $3.2k
9	Cigna Healthspring fee schedule · outpatient · +3 other terms	116	$714	$744	$39	5%	—	$667 – $915
10	Anthem fee schedule · outpatient · +15 other terms	86	$672	$1.2k	$1.1k	92%	—	$404 – $5.8k
11	Kaiser fee schedule · outpatient · +12 other terms	80	$686	$1.3k	$834	67%	—	$27 – $5.0k
12	Ambetter facility · fee schedule · outpatient · +10 other terms	45	$1.3k	$1.3k	$223	17%	—	$654 – $1.7k
13	Caresource fee schedule · outpatient · +7 other terms	44	$667	$626	$241	38%	—	$356 – $1.2k
14	Superior Healthplan fee schedule · outpatient · +2 other terms	40	$791	$791	$4	0%	—	$739 – $791
15	Clover fee schedule · outpatient · +2 other terms	37	$871	$798	$80	10%	—	$667 – $889
16	Oscar fee schedule · outpatient · +8 other terms	36	$738	$863	$253	29%	—	$700 – $1.5k
17	Optum fee schedule · outpatient · +6 other terms	34	$667	$898	$461	51%	—	$27 – $1.9k
18	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$131	$117	$19	16%	—	$91 – $142
19	Medica facility · fee schedule · outpatient · +9 other terms	22	$663	$669	$200	30%	—	$206 – $1.2k
20	Regence facility · fee schedule · outpatient · +8 other terms	21	$699	$719	$77	11%	—	$568 – $851
21	Medicare fee schedule · outpatient · +5 other terms	19	$646	$665	$45	7%	—	$646 – $785
22	Amerihealth Caritas fee schedule · outpatient · +2 other terms	18	$800	$794	$15	2%	—	$760 – $801
23	Bcbs Tx fee schedule · outpatient	18	$739	$739	—	—	—	$739 – $739
24	MultiPlan fee schedule · outpatient · +12 other terms	18	$1.1k	$1.2k	$1.5k	117%	—	$111 – $3.8k
25	Tricare facility · fee schedule · outpatient · +4 other terms	18	$785	$717	$190	27%	—	$165 – $889

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