Replacement pretibial shell for 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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Replace pretibial shell

Payers reporting HCPCS L4130

Payer pricing summary

Low

$197

Average

$755

Median

$697

High

$1.6k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +12 other terms	359	$671	$769	$404	53%	—	$334 – $5.1k
2	UnitedHealthcare fee schedule · outpatient · +15 other terms	356	$677	$658	$188	29%	—	$279 – $2.5k
3	Humana fee schedule · outpatient · +10 other terms	317	$664	$990	$1.1k	108%	—	$302 – $5.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	218	$684	$884	$449	51%	—	$0 – $3.2k
5	WellCare fee schedule · outpatient · +5 other terms	208	$684	$697	$86	12%	—	$559 – $1.1k
6	Devoted fee schedule · outpatient · +3 other terms	165	$664	$667	$18	3%	—	$629 – $775
7	Molina fee schedule · outpatient · +5 other terms	138	$926	$923	$350	38%	—	$351 – $1.7k
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$678	$674	$29	4%	—	$604 – $783
9	Cigna fee schedule · outpatient · +9 other terms	102	$691	$752	$188	25%	—	$587 – $1.7k
10	Anthem fee schedule · outpatient · +6 other terms	81	$642	$845	$768	91%	—	$331 – $4.4k
11	Kaiser fee schedule · outpatient · +6 other terms	64	$668	$1.2k	$911	77%	—	$630 – $5.6k
12	Superior Healthplan fee schedule · outpatient	40	$698	$697	$3	0%	—	$651 – $698
13	Clover fee schedule · outpatient · +2 other terms	37	$671	$637	$70	11%	—	$559 – $760
14	Oscar fee schedule · outpatient · +4 other terms	36	$704	$784	$211	27%	—	$648 – $1.3k
15	Ambetter facility · fee schedule · outpatient · +6 other terms	35	$1.1k	$1.2k	$298	24%	—	$559 – $1.7k
16	Optum fee schedule · outpatient · +2 other terms	33	$671	$854	$361	42%	—	$568 – $1.7k
17	Caresource fee schedule · outpatient · +5 other terms	28	$671	$677	$165	24%	—	$331 – $910
18	Regence facility · fee schedule · outpatient · +4 other terms	19	$681	$687	$22	3%	—	$633 – $728
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$805	$774	$66	9%	—	$592 – $805
20	Bcbs Tx fee schedule · outpatient	18	$651	$651	—	—	—	$651 – $651
21	Medicare fee schedule · outpatient · +1 other terms	18	$630	$632	$5	1%	—	$630 – $642
22	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$589	$681	$169	25%	—	$321 – $931
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$536	$536	$125	23%	—	$261 – $628
24	Wellmark fee schedule · both · +1 other terms	13	$585	$581	$25	4%	—	$429 – $585
25	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$311	$456	$171	37%	—	$311 – $658

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