Custom molded shoe, removable prosthetic

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

Custom mold shoe remov prost

Payers reporting HCPCS L3250

Payer pricing summary

Low

Average

$288

Median

$170

High

$1.3k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +9 other terms	47	$1.6k	$1.4k	$752	53%	—	$112 – $2.2k
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +8 other terms	37	$420	$821	$783	95%	—	$124 – $2.9k
3	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$42	$37	$6	16%	—	$29 – $45
4	UnitedHealthcare fee schedule · both · +11 other terms	26	$132	$251	$154	62%	—	$129 – $612
5	Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges	25	$10	$10	$3	32%	—	$5 – $20
6	Aetna fee schedule · outpatient · +10 other terms	19	$125	$267	$296	111%	—	$113 – $1.4k
7	Anthem facility · case rate · outpatient · +7 other terms	16	$29	$82	$113	138%	—	$20 – $335
8	Caresource facility · case rate · outpatient · +4 other terms	16	$30	$67	$98	146%	—	$20 – $335
9	Ambetter facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	15	$42	$39	$8	20%	—	$12 – $42
10	Cigna fee schedule · both · +7 other terms	15	$512	$442	$132	30%	—	$138 – $512
11	Molina facility · case rate · outpatient · +3 other terms	15	$29	$31	$7	23%	—	$20 – $49
12	Wellmark fee schedule · both · +1 other terms	13	$217	$224	$45	20%	—	$217 – $500
13	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$436	$323	$192	59%	—	$124 – $546
14	Regence fee schedule · outpatient · +1 other terms	12	$252	$273	$71	26%	—	$197 – $652
15	Optum facility · case rate · outpatient · +1 other terms	11	$27	$30	$7	22%	—	$24 – $44
16	Highmark fee schedule · outpatient · +1 other terms	10	$330	$330	—	—	—	$330 – $330
17	Medica fee schedule · outpatient · +5 other terms	10	$449	$450	$116	26%	—	$272 – $579
18	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$115	$115	—	—	—	$115 – $115
19	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$166	$172	$10	6%	—	$165 – $187
20	First Health professional · fee schedule · both · +5 other terms	3	$127	$127	—	—	—	$127 – $127
21	Kaiser fee schedule · both · +2 other terms	2	$677	$677	—	—	—	$677 – $677
22	Bcbs Id facility · fee schedule · outpatient	1	$130	$130	—	—	—	$130 – $130
23	Bcbs Il professional · fee schedule · both	1	$500	$500	—	—	—	$500 – $500
24	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
25	Bcbs Nc facility · fee schedule · outpatient	1	$170	$170	$28	17%	—	$150 – $210

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