Upper arm prosthesis addition, ultralight material

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

Add ue prost a/e ultlite mat

Payers reporting HCPCS L7401

Payer pricing summary

Low

$107

Average

$478

Median

$445

High

$937

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +10 other terms	361	$427	$489	$227	46%	—	$204 – $2.8k
2	UnitedHealthcare fee schedule · outpatient · +11 other terms	358	$427	$428	$98	23%	—	$185 – $1.4k
3	Humana fee schedule · outpatient · +9 other terms	319	$423	$633	$680	107%	—	$221 – $3.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +8 other terms	219	$433	$555	$290	52%	—	$0 – $2.0k
5	WellCare fee schedule · outpatient · +6 other terms	208	$437	$449	$67	15%	—	$404 – $805
6	Devoted fee schedule · outpatient · +3 other terms	165	$425	$427	$10	2%	—	$410 – $513
7	Molina fee schedule · outpatient · +4 other terms	140	$605	$588	$223	38%	—	$286 – $1.1k
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$433	$433	$15	3%	—	$425 – $518
9	Cigna fee schedule · outpatient · +9 other terms	102	$438	$484	$132	27%	—	$410 – $1.2k
10	Anthem fee schedule · outpatient · +6 other terms	80	$419	$577	$559	97%	—	$277 – $3.2k
11	Kaiser fee schedule · outpatient · +3 other terms	64	$436	$679	$476	70%	—	$410 – $3.0k
12	Ambetter facility · fee schedule · outpatient · +5 other terms	45	$634	$751	$197	26%	—	$306 – $1.1k
13	Superior Healthplan fee schedule · outpatient	40	$446	$446	$2	0%	—	$416 – $446
14	Clover fee schedule · outpatient · +3 other terms	37	$425	$427	$23	5%	—	$404 – $503
15	Oscar fee schedule · outpatient · +3 other terms	36	$446	$490	$104	21%	—	$416 – $715
16	Optum fee schedule · outpatient · +3 other terms	33	$425	$555	$225	41%	—	$408 – $1.1k
17	Caresource fee schedule · outpatient · +4 other terms	28	$425	$458	$113	25%	—	$277 – $653
18	Regence facility · fee schedule · outpatient · +3 other terms	19	$444	$426	$34	8%	—	$344 – $453
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$510	$496	$28	6%	—	$421 – $510
20	Bcbs Tx fee schedule · outpatient	18	$416	$416	—	—	—	$416 – $416
21	Medicare fee schedule · outpatient · +1 other terms	18	$410	$412	$3	1%	—	$410 – $419
22	Medical Mutual facility · fee schedule · outpatient · +1 other terms	15	$422	$487	$120	25%	—	$230 – $667
23	Tricare facility · fee schedule · outpatient · +2 other terms	15	$412	$410	$11	3%	—	$371 – $419
24	Highmark facility · fee schedule · outpatient · +4 other terms	14	$734	$712	$294	41%	—	$396 – $1.2k
25	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$384	$384	$90	23%	—	$187 – $450

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