Lower extremity orthosis addition, lightweight composite segment

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 Add Le Lamin/Prepreg Carbon Graphite P/Seg T1

Payers reporting HCPCS L2755

Payer pricing summary

Low

$41

Average

$215

Median

$200

High

$486

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +17 other terms	367	$163	$172	$70	40%	—	$61 – $595
2	Aetna fee schedule · outpatient · +16 other terms	362	$162	$186	$86	46%	—	$80 – $1.0k
3	Humana fee schedule · outpatient · +16 other terms	320	$161	$241	$258	107%	—	$82 – $1.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	223	$165	$215	$118	55%	—	$0 – $829
5	WellCare fee schedule · outpatient · +7 other terms	209	$166	$171	$25	15%	—	$154 – $306
6	Devoted fee schedule · outpatient · +5 other terms	165	$161	$162	$4	2%	—	$156 – $195
7	Molina fee schedule · outpatient · +11 other terms	144	$228	$218	$85	39%	—	$61 – $423
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$165	$165	$6	3%	—	$161 – $197
9	Cigna fee schedule · outpatient · +14 other terms	111	$166	$220	$123	56%	—	$101 – $663
10	Anthem fee schedule · outpatient · +15 other terms	86	$159	$227	$204	90%	—	$89 – $1.2k
11	Kaiser fee schedule · outpatient · +11 other terms	68	$166	$261	$186	71%	—	$89 – $1.2k
12	Ambetter facility · fee schedule · outpatient · +8 other terms	46	$242	$287	$71	25%	—	$154 – $404
13	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$170	$169	$1	0%	—	$158 – $170
14	Clover fee schedule · outpatient · +3 other terms	37	$161	$162	$9	5%	—	$154 – $191
15	Oscar fee schedule · outpatient · +7 other terms	36	$170	$186	$40	21%	—	$158 – $272
16	Optum fee schedule · outpatient · +7 other terms	33	$161	$211	$85	41%	—	$155 – $404
17	Caresource fee schedule · outpatient · +6 other terms	29	$161	$168	$48	29%	—	$88 – $248
18	Medica facility · fee schedule · outpatient · +8 other terms	23	$164	$151	$39	26%	—	$54 – $266
19	Amerihealth Caritas fee schedule · outpatient · +2 other terms	18	$194	$188	$11	6%	—	$160 – $194
20	Bcbs Tx fee schedule · outpatient	18	$158	$158	—	—	—	$158 – $158
21	Medicare fee schedule · outpatient · +4 other terms	18	$156	$157	$1	1%	—	$156 – $159
22	Regence facility · fee schedule · outpatient · +7 other terms	17	$169	$164	$12	8%	—	$131 – $172
23	Tricare facility · fee schedule · outpatient · +4 other terms	16	$157	$156	$4	3%	—	$141 – $159
24	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$161	$185	$46	25%	—	$87 – $254
25	Highmark facility · fee schedule · outpatient · +5 other terms	14	$268	$262	$108	41%	—	$151 – $446

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