Custom molded plastazote shoe insert at Dignity Health

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

ORTHO L3253 115X-150

Long Beach, CA

See all hospitals reporting HCPCS L3253 →

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Pricing by billing methodology

Price type

How this price compares nationally

Dignity Health’s median price of $230 is 209% above the median hospital's median price ($75), higher than 89% of the 352 hospitals reporting HCPCS L3253. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L3253 at Dignity Health

Negotiated rates from the hospital’s own file: 8 payers, 28 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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#
1	Anthem medicaid\|all plans fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
2	Molina medicaid\|all plans fee schedule · outpatient	$101	$101	—	—	—	$101 – $101
3	Kaiser medicaid\|< 21 fee schedule · outpatient	$108	$108	—	—	—	$108 – $108
4	Kaiser medicaid\|> 21 fee schedule · outpatient	$108	$108	—	—	—	$108 – $108
5	Anthem medicaid\|all plans fee schedule · inpatient	$133	$133	$18	13%	—	$115 – $150
6	Molina medicaid\|all plans fee schedule · inpatient	$152	$152	$20	13%	—	$132 – $173
7	Cigna commercial\|all other plans fee schedule · inpatient	$199	$199	$26	13%	—	$173 – $225
8	Cigna commercial\|ppo fee schedule · inpatient	$199	$199	$26	13%	—	$173 – $225
9	Anthem commercial\|exchange fee schedule · outpatient	$225	$225	$30	13%	—	$196 – $255
10	Blue Cross Blue Shield commercial\|exchange fee schedule · inpatient	$272	$272	$36	13%	—	$236 – $308
11	UnitedHealthcare commercial\|non-options ppo fee schedule · outpatient	$311	$311	$41	13%	—	$270 – $353
12	Anthem commercial\|all other plans fee schedule · outpatient	$331	$331	$44	13%	—	$288 – $375
13	Anthem commercial\|mcs fee schedule · outpatient	$331	$331	$44	13%	—	$288 – $375
14	UnitedHealthcare commercial\|all other plans fee schedule · outpatient	$331	$331	$44	13%	—	$288 – $375
15	UnitedHealthcare commercial\|options ppo fee schedule · outpatient	$331	$331	$44	13%	—	$288 – $375
16	UnitedHealthcare commercial\|hmo fee schedule · outpatient	$345	$345	$46	13%	—	$299 – $390
17	Blue Cross Blue Shield medicaid\|all plans fee schedule · outpatient	$361	$361	—	—	—	$361 – $361
18	Blue Cross Blue Shield commercial\|all other plans fee schedule · inpatient	$364	$364	$48	13%	—	$316 – $413
19	Aetna commercial\|all other plans fee schedule · inpatient	$384	$384	$51	13%	—	$334 – $435
20	Aetna commercial\|hmo fee schedule · inpatient	$384	$384	$51	13%	—	$334 – $435
21	Aetna commercial\|ppo fee schedule · inpatient	$384	$384	$51	13%	—	$334 – $435
22	Blue Cross Blue Shield medicare\|blueshield promise fee schedule · outpatient	$431	$431	$57	13%	—	$374 – $488
23	Cigna commercial\|all other plans fee schedule · outpatient	$451	$451	$60	13%	—	$391 – $510
24	Cigna commercial\|ppo fee schedule · outpatient	$451	$451	$60	13%	—	$391 – $510
25	Kaiser commercial\|all plans fee schedule · inpatient	$464	$464	$61	13%	—	$403 – $525

Page 1 of 2 · 28 rates

Last updated: Feb 28, 2026

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See Custom molded plastazote shoe insert pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.