Replacement of metal bands on 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

Repl met band kafo-afo calf/

Payers reporting HCPCS L4090

Payer pricing summary

Low

$33

Average

$137

Median

$126

High

$348

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +11 other terms	359	$121	$139	$74	53%	—	$54 – $924
2	UnitedHealthcare fee schedule · outpatient · +13 other terms	356	$118	$117	$34	29%	—	$51 – $459
3	Humana fee schedule · outpatient · +9 other terms	317	$113	$183	$214	117%	—	$53 – $1.0k
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	218	$130	$159	$82	52%	—	$0 – $633
5	WellCare fee schedule · outpatient · +6 other terms	208	$129	$132	$23	18%	—	$100 – $241
6	Devoted fee schedule · outpatient · +3 other terms	165	$109	$124	$12	10%	—	$100 – $141
7	Molina fee schedule · outpatient · +5 other terms	138	$162	$176	$69	39%	—	$64 – $344
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$116	$125	$10	8%	—	$104 – $142
9	Cigna fee schedule · outpatient · +10 other terms	102	$124	$132	$39	29%	—	$100 – $309
10	Anthem fee schedule · outpatient · +7 other terms	80	$104	$145	$137	94%	—	$60 – $779
11	Kaiser fee schedule · outpatient · +6 other terms	64	$106	$207	$169	82%	—	$100 – $1.0k
12	Superior Healthplan fee schedule · outpatient	40	$138	$138	$1	0%	—	$129 – $138
13	Clover fee schedule · outpatient · +3 other terms	37	$121	$122	$9	8%	—	$109 – $138
14	Oscar fee schedule · outpatient · +4 other terms	36	$129	$142	$35	25%	—	$114 – $226
15	Ambetter facility · fee schedule · outpatient · +6 other terms	35	$187	$210	$42	20%	—	$107 – $272
16	Optum fee schedule · outpatient · +4 other terms	33	$109	$156	$79	51%	—	$100 – $328
17	Caresource fee schedule · outpatient · +5 other terms	28	$109	$114	$29	26%	—	$60 – $161
18	Regence facility · fee schedule · outpatient · +3 other terms	19	$108	$113	$9	8%	—	$104 – $132
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$130	$127	$7	6%	—	$107 – $130
20	Bcbs Tx fee schedule · outpatient	18	$129	$129	—	—	—	$129 – $129
21	Medicare fee schedule · outpatient · +1 other terms	18	$100	$100	$1	1%	—	$100 – $102
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$104	$120	$30	25%	—	$57 – $164
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$94	$94	$22	23%	—	$46 – $111
24	Wellmark fee schedule · both · +1 other terms	13	$124	$123	$8	6%	—	$76 – $124
25	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$55	$76	$25	33%	—	$55 – $107

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