Removable premolded arch support for foot

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

FT ARCH SUPRT PREMOLD LONGIT

Payers reporting HCPCS L3040

Payer pricing summary

Low

$30

Average

$72

Median

$63

High

$166

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +19 other terms	381	$58	$65	$37	57%	—	$1 – $281
2	Aetna fee schedule · outpatient · +20 other terms	371	$58	$66	$31	46%	—	$1 – $377
3	Humana fee schedule · outpatient · +19 other terms	328	$58	$85	$92	107%	—	$1 – $447
4	Blue Cross Blue Shield fee schedule · outpatient · +20 other terms	240	$59	$77	$42	54%	—	$0 – $374
5	WellCare fee schedule · outpatient · +10 other terms	209	$60	$61	$9	15%	—	$55 – $110
6	Devoted fee schedule · outpatient · +5 other terms	165	$58	$58	$1	2%	—	$56 – $70
7	Molina fee schedule · outpatient · +14 other terms	149	$75	$76	$30	39%	—	$1 – $152
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$59	$59	$2	3%	—	$58 – $71
9	Cigna fee schedule · outpatient · +21 other terms	114	$60	$85	$58	68%	—	$36 – $299
10	Anthem fee schedule · outpatient · +19 other terms	85	$57	$85	$73	85%	—	$25 – $434
11	Kaiser fee schedule · outpatient · +11 other terms	69	$60	$97	$69	71%	—	$56 – $414
12	Ambetter facility · fee schedule · outpatient · +11 other terms	43	$98	$104	$27	26%	—	$42 – $145
13	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$61	$61	$0	0%	—	$57 – $61
14	Clover fee schedule · outpatient · +3 other terms	37	$58	$59	$3	5%	—	$55 – $69
15	Optum fee schedule · outpatient · +11 other terms	36	$58	$74	$30	40%	—	$56 – $145
16	Oscar fee schedule · outpatient · +10 other terms	36	$61	$67	$14	21%	—	$57 – $98
17	Caresource fee schedule · outpatient · +10 other terms	29	$58	$57	$22	39%	—	$1 – $89
18	Medica facility · fee schedule · outpatient · +12 other terms	22	$59	$54	$14	26%	—	$19 – $96
19	Medicare fee schedule · outpatient · +4 other terms	19	$56	$57	$1	1%	—	$56 – $58
20	Amerihealth Caritas fee schedule · outpatient · +3 other terms	18	$70	$68	$4	6%	—	$58 – $70
21	Bcbs Tx fee schedule · outpatient	18	$57	$57	—	—	—	$57 – $57
22	Regence facility · fee schedule · outpatient · +7 other terms	17	$61	$59	$4	8%	—	$47 – $62
23	Medical Mutual facility · fee schedule · outpatient · +5 other terms	15	$58	$67	$16	25%	—	$31 – $91
24	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$53	$53	$12	23%	—	$26 – $62
25	Tricare facility · fee schedule · outpatient · +6 other terms	13	$56	$58	$6	10%	—	$51 – $77

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