Felt-covered leather orthopedic shoe insole

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

O shoe add felt w leath insl

Payers reporting HCPCS L3520

Payer pricing summary

Low

$10

Average

$46

Median

$41

High

$107

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +9 other terms	358	$39	$45	$21	46%	—	$20 – $255
2	UnitedHealthcare fee schedule · outpatient · +9 other terms	355	$39	$40	$9	23%	—	$8 – $126
3	Humana fee schedule · outpatient · +9 other terms	316	$39	$59	$63	108%	—	$20 – $302
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	216	$40	$51	$27	52%	—	$0 – $187
5	WellCare fee schedule · outpatient · +4 other terms	208	$40	$42	$6	15%	—	$37 – $74
6	Devoted fee schedule · outpatient · +3 other terms	165	$39	$39	$1	2%	—	$38 – $47
7	Molina fee schedule · outpatient · +4 other terms	137	$56	$54	$20	37%	—	$29 – $103
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$40	$40	$1	3%	—	$39 – $48
9	Cigna fee schedule · outpatient · +6 other terms	102	$40	$45	$12	27%	—	$38 – $114
10	Anthem fee schedule · outpatient · +6 other terms	80	$39	$54	$52	96%	—	$37 – $293
11	Kaiser fee schedule · outpatient · +4 other terms	64	$40	$63	$44	70%	—	$38 – $280
12	Superior Healthplan fee schedule · outpatient	40	$41	$41	$0	0%	—	$39 – $41
13	Clover fee schedule · outpatient · +2 other terms	37	$39	$40	$2	5%	—	$37 – $47
14	Oscar fee schedule · outpatient · +3 other terms	36	$41	$45	$10	21%	—	$38 – $66
15	Ambetter facility · fee schedule · outpatient · +5 other terms	33	$70	$74	$18	24%	—	$37 – $98
16	Optum fee schedule · outpatient · +2 other terms	33	$39	$51	$21	40%	—	$38 – $98
17	Caresource fee schedule · outpatient · +4 other terms	26	$39	$45	$9	20%	—	$39 – $60
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$40	$37	$10	26%	—	$13 – $65
19	Regence facility · fee schedule · outpatient · +3 other terms	19	$41	$39	$3	8%	—	$32 – $42
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$47	$46	$3	6%	—	$39 – $47
21	Bcbs Tx fee schedule · outpatient	18	$39	$39	—	—	—	$39 – $39
22	Medicare fee schedule · outpatient · +1 other terms	18	$38	$38	$0	1%	—	$38 – $39
23	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$39	$45	$11	25%	—	$21 – $62
24	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$36	$36	$8	23%	—	$17 – $42
25	Wellmark fee schedule · both · +1 other terms	13	$36	$36	$1	3%	—	$28 – $36

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