Prefabricated ankle control orthosis (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

BRACE ANKLE ADULT UNIVERSAL GEL AIR LINER ANATOMICALLY SHAPE HOOK LOOP STRAP CS/25EA

Medicaid pricing summary

Low

Average

$92

Median

$86

High

$959

Medicaid rate distribution

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58 hospital rates

#		Plans
1	Allina Health Systems Ulm, MN facility · other · outpatient	1	$28	$47	$43	91%	1–10	$12 – $120
2	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient	1	$103	$103	—	—	—	$103 – $103
3	ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient	1	$72	$72	—	—	—	$72 – $72
4	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient	1	$87	$87	$16	18%	—	$72 – $103
5	ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient	1	$103	$103	—	—	—	$103 – $103
6	Allina Health Systems Shakopee, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
7	Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
8	Allina Health Systems Owatonna, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
9	Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
10	Allina Health Systems Cambridge, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
11	Allina Health Systems River Falls, WI facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
12	Allina Health Systems Minneapolis, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
13	Allina Health Systems Buffalo, MN facility · fee schedule · outpatient	1	$73	$74	$34	45%	—	$31 – $119
14	Brookings Health System Brookings, SD fee schedule · outpatient	1	$24	$24	—	—	—	$24 – $24
15	CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient	1	$86	$86	—	—	—	$86 – $86
16	Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges	1	$8	$8	—	—	—	$8 – $8
17	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL CARMEL, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140
18	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CROWN POINT CROWN POINT, IN fee schedule · both	14	$117	$122	$10	8%	—	$117 – $140
19	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH DYER DYER, IN fee schedule · both	14	$117	$122	$10	8%	—	$117 – $140
20	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS, IN fee schedule · both	16	$117	$122	$10	8%	—	$117 – $140
21	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH LAFAYETTE LAFAYETTE, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140
22	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY CITY, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140
23	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY LAPORTE PORTE, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140
24	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MOORESVILLE MOORESVILLE, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140
25	FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MUNSTER MUNSTER, IN fee schedule · both	2	$128	$128	$12	9%	—	$117 – $140

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HCPCS L4350