Upper arm prosthesis addition, acrylic, above-elbow

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 acrylic

Payers reporting HCPCS L7404

Payer pricing summary

Low

$173

Average

$764

Median

$715

High

$1.5k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +10 other terms	361	$691	$792	$368	46%	—	$330 – $4.5k
2	UnitedHealthcare fee schedule · outpatient · +12 other terms	358	$691	$694	$158	23%	—	$299 – $2.2k
3	Humana fee schedule · outpatient · +10 other terms	319	$685	$1.0k	$1.1k	107%	—	$358 – $5.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	219	$702	$897	$470	52%	—	$0 – $3.3k
5	WellCare fee schedule · outpatient · +6 other terms	208	$709	$727	$108	15%	—	$655 – $1.3k
6	Devoted fee schedule · outpatient · +3 other terms	165	$688	$692	$16	2%	—	$665 – $831
7	Molina fee schedule · outpatient · +5 other terms	139	$980	$946	$354	37%	—	$463 – $1.8k
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$702	$701	$24	3%	—	$688 – $839
9	Cigna fee schedule · outpatient · +9 other terms	102	$709	$784	$214	27%	—	$665 – $2.0k
10	Anthem fee schedule · outpatient · +6 other terms	80	$678	$934	$905	97%	—	$448 – $5.1k
11	Kaiser fee schedule · outpatient · +4 other terms	64	$706	$1.1k	$771	70%	—	$665 – $4.9k
12	Ambetter facility · fee schedule · outpatient · +5 other terms	46	$998	$1.2k	$318	26%	—	$497 – $1.7k
13	Superior Healthplan fee schedule · outpatient	40	$722	$722	$3	0%	—	$675 – $722
14	Clover fee schedule · outpatient · +3 other terms	37	$688	$692	$37	5%	—	$655 – $815
15	Oscar fee schedule · outpatient · +3 other terms	36	$722	$794	$168	21%	—	$674 – $1.2k
16	Optum fee schedule · outpatient · +3 other terms	33	$688	$899	$364	41%	—	$660 – $1.7k
17	Caresource fee schedule · outpatient · +4 other terms	28	$688	$742	$184	25%	—	$448 – $1.1k
18	Regence facility · fee schedule · outpatient · +4 other terms	19	$720	$690	$55	8%	—	$557 – $733
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$826	$803	$46	6%	—	$681 – $826
20	Bcbs Tx fee schedule · outpatient	18	$675	$675	—	—	—	$675 – $675
21	Medicare fee schedule · outpatient · +1 other terms	18	$665	$667	$5	1%	—	$665 – $678
22	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$684	$789	$195	25%	—	$373 – $1.1k
23	Tricare facility · fee schedule · outpatient · +2 other terms	15	$668	$664	$18	3%	—	$601 – $678
24	Highmark facility · fee schedule · outpatient · +4 other terms	14	$1.2k	$1.2k	$478	41%	—	$642 – $1.9k
25	Bcbs Mn fee schedule · outpatient · +4 other terms	13	$623	$622	$145	23%	—	$303 – $729

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