Sock for upper extremity orthosis

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

SOCK FRACTURE OR EQUAL EACH

Payers reporting HCPCS L3995

Payer pricing summary

Low

$11

Average

$87

Median

$56

High

$805

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +23 other terms	398	$44	$56	$43	78%	—	$1 – $296
2	Aetna fee schedule · outpatient · +22 other terms	367	$46	$51	$29	57%	—	$17 – $273
3	Humana fee schedule · outpatient · +20 other terms	326	$40	$64	$77	120%	—	$15 – $369
4	Blue Cross Blue Shield fee schedule · outpatient · +19 other terms	233	$47	$62	$45	74%	—	$0 – $469
5	WellCare fee schedule · outpatient · +12 other terms	213	$47	$47	$10	22%	—	$12 – $96
6	Devoted fee schedule · outpatient · +6 other terms	164	$38	$44	$5	11%	—	$35 – $51
7	Molina fee schedule · outpatient · +17 other terms	151	$52	$59	$25	43%	—	$27 – $126
8	Cigna fee schedule · outpatient · +19 other terms	123	$47	$86	$79	91%	—	$19 – $454
9	Cigna Healthspring fee schedule · outpatient · +3 other terms	116	$41	$45	$4	9%	—	$37 – $50
10	Anthem fee schedule · outpatient · +20 other terms	96	$39	$98	$100	102%	—	$14 – $485
11	Kaiser fee schedule · outpatient · +13 other terms	79	$38	$71	$56	79%	—	$23 – $300
12	Ambetter facility · fee schedule · outpatient · +10 other terms	49	$68	$74	$15	20%	—	$38 – $103
13	MultiPlan fee schedule · outpatient · +13 other terms	40	$55	$141	$108	77%	—	$32 – $483
14	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$50	$50	$0	0%	—	$47 – $50
15	Clover fee schedule · outpatient · +3 other terms	37	$48	$46	$4	9%	—	$38 – $50
16	Oscar fee schedule · outpatient · +7 other terms	36	$47	$50	$11	21%	—	$40 – $73
17	Optum fee schedule · outpatient · +9 other terms	34	$38	$69	$52	75%	—	$32 – $288
18	Caresource fee schedule · outpatient · +8 other terms	31	$38	$43	$15	34%	—	$24 – $71
19	Medica fee schedule · outpatient · +11 other terms	28	$55	$64	$29	45%	—	$15 – $115
20	Tricare facility · fee schedule · outpatient · +8 other terms	23	$40	$42	$4	9%	—	$36 – $49
21	Medicare fee schedule · outpatient · +2 other terms	19	$35	$36	$2	5%	—	$35 – $45
22	Amerihealth Caritas fee schedule · outpatient · +4 other terms	18	$46	$45	$2	4%	—	$41 – $46
23	Bcbs Tx fee schedule · outpatient · +2 other terms	18	$47	$47	—	—	—	$47 – $47
24	Regence facility · fee schedule · outpatient · +6 other terms	17	$38	$38	$1	3%	—	$34 – $39
25	First Health fee schedule · outpatient · +10 other terms	16	$148	$175	$91	52%	—	$47 – $428

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