Infant high-top orthopedic shoes with arch support

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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ORTHOPEDIC SHOE; HIGHTOP WITH SUPINATOR OR PRONATOR; INFANT

Payers reporting HCPCS L3204

Payer pricing summary

Low

Average

$118

Median

$59

High

$1.3k

Payer rate distribution

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Filter by billing class

#
1	Humana fee schedule · outpatient · +8 other terms	46	$244	$221	$114	52%	—	$17 – $332
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +9 other terms	38	$58	$149	$174	117%	—	$20 – $617
3	UnitedHealthcare fee schedule · both · +11 other terms	26	$20	$38	$24	62%	—	$20 – $94
4	Aetna fee schedule · outpatient · +11 other terms	19	$19	$41	$45	111%	—	$17 – $218
5	Anthem facility · case rate · outpatient · +6 other terms	15	$29	$31	$7	23%	—	$20 – $49
6	Caresource facility · case rate · outpatient · +4 other terms	15	$29	$31	$7	23%	—	$20 – $50
7	Cigna fee schedule · both · +8 other terms	15	$78	$68	$21	31%	—	$19 – $78
8	Molina facility · case rate · outpatient · +3 other terms	15	$29	$31	$7	23%	—	$20 – $49
9	Wellmark fee schedule · both · +3 other terms	13	$45	$47	$10	22%	—	$45 – $110
10	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$179	$135	$77	57%	—	$56 – $224
11	Regence fee schedule · outpatient · +1 other terms	12	$39	$42	$11	26%	—	$30 – $100
12	Optum facility · case rate · outpatient · +1 other terms	11	$27	$30	$7	22%	—	$24 – $44
13	Highmark fee schedule · outpatient · +1 other terms	10	$39	$39	—	—	—	$39 – $39
14	Medica fee schedule · outpatient · +4 other terms	10	$69	$69	$18	26%	—	$42 – $89
15	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$18	$18	—	—	—	$18 – $18
16	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$169	$176	$10	6%	—	$168 – $191
17	First Health professional · fee schedule · both · +4 other terms	3	$19	$19	—	—	—	$19 – $19
18	Kaiser fee schedule · both · +2 other terms	2	$104	$104	—	—	—	$104 – $104
19	Medcost percent of total billed charges · bothfrom % of charges	2	$201	$201	$10	5%	—	$186 – $209
20	WellCare percent of total billed charges · bothfrom % of charges	2	$80	$80	—	—	—	$80 – $80
21	Ambetter facility · fee schedule · outpatient · +1 other terms	1	$20	$20	—	—	—	$20 – $20
22	Bcbs Id facility · fee schedule · outpatient	1	$29	$29	—	—	—	$29 – $29
23	Bcbs Il professional · fee schedule · both	1	$110	$110	—	—	—	$110 – $110
24	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
25	Bcbs Nc facility · fee schedule · outpatient	1	$32	$32	$13	40%	—	$23 – $50

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