Replacement lacer for custom leg brace

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

Replace non-molded calf lace

Payers reporting HCPCS L4055

Payer pricing summary

Low

$106

Average

$371

Median

$332

High

$864

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +8 other terms	359	$314	$374	$229	61%	—	$153 – $3.5k
2	UnitedHealthcare fee schedule · outpatient · +10 other terms	356	$310	$313	$89	28%	—	$64 – $1.0k
3	Humana fee schedule · outpatient · +9 other terms	317	$307	$472	$507	107%	—	$158 – $2.4k
4	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	218	$313	$435	$243	56%	—	$0 – $1.5k
5	WellCare fee schedule · outpatient · +4 other terms	208	$322	$332	$52	16%	—	$296 – $599
6	Devoted fee schedule · outpatient · +3 other terms	165	$307	$313	$11	3%	—	$295 – $418
7	Molina fee schedule · outpatient · +5 other terms	138	$457	$436	$163	37%	—	$182 – $820
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$319	$318	$14	4%	—	$307 – $422
9	Cigna fee schedule · outpatient · +7 other terms	102	$322	$358	$99	28%	—	$295 – $900
10	Anthem fee schedule · outpatient · +6 other terms	80	$307	$432	$405	94%	—	$171 – $2.3k
11	Kaiser fee schedule · outpatient · +5 other terms	64	$313	$529	$374	71%	—	$295 – $2.3k
12	Superior Healthplan fee schedule · outpatient	40	$329	$328	$2	0%	—	$307 – $329
13	Clover fee schedule · outpatient · +2 other terms	37	$307	$315	$19	6%	—	$301 – $410
14	Oscar fee schedule · outpatient · +4 other terms	36	$323	$381	$125	33%	—	$307 – $696
15	Ambetter facility · fee schedule · outpatient · +6 other terms	35	$582	$615	$113	18%	—	$301 – $864
16	Optum fee schedule · outpatient · +2 other terms	33	$307	$407	$167	41%	—	$295 – $782
17	Caresource fee schedule · outpatient · +5 other terms	28	$307	$329	$90	27%	—	$171 – $475
18	Regence facility · fee schedule · outpatient · +3 other terms	19	$319	$310	$19	6%	—	$260 – $326
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$369	$359	$18	5%	—	$313 – $369
20	Bcbs Tx fee schedule · outpatient	18	$307	$307	—	—	—	$307 – $307
21	Medicare fee schedule · outpatient · +1 other terms	18	$295	$296	$2	1%	—	$295 – $301
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$307	$356	$88	25%	—	$167 – $485
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$279	$279	$65	23%	—	$136 – $327
24	Wellmark fee schedule · both · +1 other terms	13	$306	$304	$13	4%	—	$224 – $306
25	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$162	$220	$68	31%	—	$162 – $301

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