Custom-fitted replacement prosthetic socket brim

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

Replace socket brim cust fit

Payers reporting HCPCS L4030

Payer pricing summary

Low

$201

Average

$776

Median

$705

High

$2.2k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +10 other terms	359	$742	$786	$432	55%	—	$289 – $5.1k
2	UnitedHealthcare fee schedule · outpatient · +12 other terms	356	$727	$653	$205	31%	—	$284 – $2.5k
3	Humana fee schedule · outpatient · +10 other terms	317	$603	$1.0k	$1.2k	120%	—	$369 – $5.8k
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	218	$742	$913	$526	58%	—	$0 – $3.6k
5	WellCare fee schedule · outpatient · +6 other terms	208	$742	$751	$162	22%	—	$569 – $1.5k
6	Devoted fee schedule · outpatient · +4 other terms	165	$580	$696	$86	12%	—	$557 – $810
7	Molina fee schedule · outpatient · +4 other terms	138	$1.1k	$1.0k	$398	39%	—	$391 – $2.0k
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$621	$706	$74	10%	—	$580 – $796
9	Cigna fee schedule · outpatient · +8 other terms	102	$611	$732	$262	36%	—	$557 – $2.2k
10	Anthem fee schedule · outpatient · +7 other terms	81	$580	$903	$1.0k	114%	—	$369 – $5.7k
11	Kaiser fee schedule · outpatient · +5 other terms	64	$592	$1.2k	$932	80%	—	$557 – $5.6k
12	Superior Healthplan fee schedule · outpatient	40	$795	$794	$4	0%	—	$742 – $795
13	Clover fee schedule · outpatient · +2 other terms	37	$758	$716	$80	11%	—	$580 – $795
14	Ambetter facility · fee schedule · outpatient · +7 other terms	36	$1.2k	$1.2k	$216	18%	—	$569 – $1.5k
15	Oscar fee schedule · outpatient · +4 other terms	36	$742	$809	$216	27%	—	$609 – $1.3k
16	Optum fee schedule · outpatient · +3 other terms	33	$580	$882	$469	53%	—	$557 – $1.9k
17	Caresource fee schedule · outpatient · +5 other terms	28	$580	$695	$262	38%	—	$369 – $1.2k
18	Regence facility · fee schedule · outpatient · +3 other terms	19	$603	$631	$45	7%	—	$580 – $727
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$696	$679	$33	5%	—	$592 – $696
20	Bcbs Tx fee schedule · outpatient	18	$742	$742	—	—	—	$742 – $742
21	Medicare fee schedule · outpatient · +2 other terms	18	$557	$559	$4	1%	—	$557 – $569
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$754	$863	$215	25%	—	$410 – $1.2k
23	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$685	$685	$160	23%	—	$333 – $803
24	Medica facility · fee schedule · outpatient · +5 other terms	13	$739	$660	$177	27%	—	$251 – $997
25	Wellmark fee schedule · both · +1 other terms	13	$558	$557	$2	0%	—	$548 – $558

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