Below-elbow prosthesis add-on, acrylic 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 b/e acrylic

Payers reporting HCPCS L7403

Payer pricing summary

Low

$115

Average

$523

Median

$480

High

$1.0k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +12 other terms	361	$458	$525	$244	46%	—	$218 – $3.0k
2	UnitedHealthcare fee schedule · outpatient · +13 other terms	358	$458	$460	$105	23%	—	$198 – $1.5k
3	Humana fee schedule · outpatient · +12 other terms	319	$454	$680	$730	107%	—	$237 – $3.5k
4	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	219	$465	$595	$311	52%	—	$0 – $2.2k
5	WellCare fee schedule · outpatient · +6 other terms	208	$470	$482	$72	15%	—	$434 – $863
6	Devoted fee schedule · outpatient · +3 other terms	165	$456	$458	$11	2%	—	$440 – $551
7	Molina fee schedule · outpatient · +5 other terms	140	$647	$625	$235	38%	—	$307 – $1.2k
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$465	$464	$16	3%	—	$456 – $556
9	Cigna fee schedule · outpatient · +11 other terms	104	$470	$516	$143	28%	—	$285 – $1.3k
10	Anthem fee schedule · outpatient · +8 other terms	80	$449	$619	$600	97%	—	$297 – $3.4k
11	Kaiser fee schedule · outpatient · +5 other terms	64	$468	$728	$511	70%	—	$440 – $3.2k
12	Ambetter facility · fee schedule · outpatient · +6 other terms	45	$680	$806	$211	26%	—	$329 – $1.1k
13	Superior Healthplan fee schedule · outpatient	40	$479	$479	$2	0%	—	$447 – $479
14	Clover fee schedule · outpatient · +3 other terms	37	$456	$459	$24	5%	—	$434 – $540
15	Oscar fee schedule · outpatient · +6 other terms	36	$479	$526	$112	21%	—	$447 – $767
16	Optum fee schedule · outpatient · +3 other terms	33	$456	$596	$241	41%	—	$437 – $1.1k
17	Caresource fee schedule · outpatient · +5 other terms	29	$456	$476	$132	28%	—	$249 – $701
18	Regence facility · fee schedule · outpatient · +4 other terms	19	$477	$457	$36	8%	—	$369 – $486
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$547	$532	$30	6%	—	$451 – $547
20	Bcbs Tx fee schedule · outpatient	18	$447	$447	—	—	—	$447 – $447
21	Medicare fee schedule · outpatient · +3 other terms	18	$440	$442	$3	1%	—	$440 – $449
22	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$453	$523	$129	25%	—	$247 – $717
23	Tricare facility · fee schedule · outpatient · +2 other terms	15	$443	$440	$12	3%	—	$398 – $449
24	Highmark facility · fee schedule · outpatient · +4 other terms	14	$765	$755	$311	41%	—	$425 – $1.3k
25	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$412	$412	$96	23%	—	$201 – $483

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