Orthotic foot device, non-standard size

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

Orth foot non-standard size/

Payers reporting HCPCS L3255

Payer pricing summary

Low

Average

$65

Median

$53

High

$169

Payer rate distribution

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#
1	Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms	37	$34	$65	$57	88%	—	$0 – $233
2	Aetna fee schedule · outpatient · +6 other terms	19	$20	$42	$36	85%	—	$20 – $126
3	Anthem facility · case rate · outpatient · +6 other terms	15	$15	$17	$4	23%	—	$10 – $26
4	Caresource facility · case rate · outpatient · +1 other terms	15	$16	$17	$4	23%	—	$10 – $27
5	Molina facility · case rate · outpatient · +4 other terms	15	$15	$17	$4	23%	—	$11 – $26
6	UnitedHealthcare facility · case rate · outpatient · +3 other terms	15	$16	$17	$4	23%	—	$11 – $27
7	Wellmark fee schedule · both · +1 other terms	13	$65	$64	$5	7%	—	$35 – $65
8	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$50	$37	$21	57%	—	$16 – $62
9	Optum facility · case rate · outpatient	11	$14	$16	$4	22%	—	$13 – $24
10	Cigna professional · fee schedule · outpatient · +3 other terms	10	$17	$17	$1	4%	—	$16 – $17
11	Aetna Better Health fee schedule · inpatient · +1 other terms	7	$20	$20	—	—	—	$20 – $20
12	Humana fee schedule · inpatient · +3 other terms	5	$20	$20	—	—	—	$20 – $20
13	Kaiser fee schedule · inpatient · +1 other terms	4	$150	$139	$38	28%	—	$77 – $179
14	MultiPlan fee schedule · inpatient · +2 other terms	4	$204	$204	—	—	—	$204 – $204
15	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$166	$172	$10	6%	—	$165 – $187
16	First Health fee schedule · inpatient · +2 other terms	3	$168	$171	$6	3%	—	$166 – $179
17	Bcbs Il professional · fee schedule · both	1	$35	$35	—	—	—	$35 – $35
18	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
19	Bcbs Nc facility · fee schedule · outpatient	1	$8	$8	—	—	—	$8 – $8
20	Bcbs Vt professional · fee schedule · outpatient	1	$24	$24	—	—	—	$24 – $24
21	Magellan fee schedule · inpatient · +1 other terms	1	$153	$153	—	—	—	$153 – $153