Men's high-top depth-inlay shoes

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

Mens shoes hightop depth inl

Payers reporting HCPCS L3222

Payer pricing summary

Low

Average

$155

Median

$132

High

$463

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +7 other terms	47	$696	$621	$330	53%	—	$49 – $947
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms	35	$195	$307	$283	92%	—	$53 – $1.3k
3	Aetna fee schedule · outpatient · +10 other terms	30	$69	$222	$243	109%	—	$30 – $750
4	UnitedHealthcare fee schedule · both · +10 other terms	26	$58	$110	$67	62%	—	$57 – $268
5	Anthem facility · fee schedule · outpatient · +9 other terms	17	$71	$180	$101	56%	—	$71 – $362
6	Caresource facility · case rate · outpatient · +2 other terms	16	$30	$36	$14	40%	—	$20 – $71
7	Cigna fee schedule · both · +8 other terms	15	$224	$193	$59	31%	—	$55 – $224
8	Molina facility · case rate · outpatient · +5 other terms	15	$29	$31	$7	23%	—	$20 – $49
9	Wellmark fee schedule · both	13	$68	$68	—	—	—	$68 – $68
10	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$340	$257	$145	56%	—	$109 – $426
11	Clover facility · percent of total billed charges · outpatientfrom % of charges	12	$25	$23	$7	30%	—	$0 – $25
12	Regence fee schedule · outpatient · +1 other terms	12	$110	$119	$31	26%	—	$86 – $285
13	Optum facility · case rate · outpatient · +2 other terms	11	$27	$30	$7	22%	—	$24 – $44
14	Highmark fee schedule · outpatient · +1 other terms	10	$253	$253	—	—	—	$253 – $253
15	Medica fee schedule · outpatient · +5 other terms	10	$196	$197	$51	26%	—	$119 – $253
16	Kaiser fee schedule · outpatient · +2 other terms	8	$185	$179	$136	76%	—	$84 – $525
17	MultiPlan fee schedule · inpatient · +8 other terms	8	$600	$669	$152	23%	—	$423 – $900
18	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$50	$50	—	—	—	$50 – $50
19	First Health fee schedule · inpatient · +4 other terms	7	$525	$584	$150	26%	—	$360 – $788
20	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$152	$158	$9	6%	—	$151 – $172
21	WellCare facility · percent of total billed charges · outpatientfrom % of charges	3	$62	$62	—	—	—	$62 – $62
22	Excellus fee schedule · outpatient	2	$90	$89	$16	18%	—	$45 – $95
23	Tricare facility · fee schedule · outpatient	2	$159	$159	—	—	—	$159 – $159
24	Ambetter facility · fee schedule · outpatient	1	$53	$53	—	—	—	$53 – $53
25	Bcbs Id facility · fee schedule · outpatient · +1 other terms	1	$65	$65	—	—	—	$65 – $65

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