Pelvic control belt for above-knee prosthesis

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

Ak pelvic control belt pad/l

Payers reporting HCPCS L5694

Payer pricing summary

Low

$77

Average

$303

Median

$283

High

$653

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +15 other terms	361	$248	$297	$168	57%	—	$106 – $2.0k
2	UnitedHealthcare fee schedule · outpatient · +16 other terms	358	$243	$244	$82	34%	—	$80 – $979
3	Humana fee schedule · outpatient · +13 other terms	319	$238	$398	$485	122%	—	$116 – $2.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +12 other terms	219	$290	$337	$179	53%	—	$0 – $1.4k
5	WellCare fee schedule · outpatient · +6 other terms	208	$290	$286	$45	16%	—	$214 – $433
6	Devoted fee schedule · outpatient · +4 other terms	165	$243	$273	$33	12%	—	$222 – $317
7	Molina fee schedule · outpatient · +9 other terms	140	$351	$391	$157	40%	—	$86 – $776
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$238	$276	$29	11%	—	$222 – $305
9	Cigna fee schedule · outpatient · +13 other terms	102	$243	$283	$79	28%	—	$218 – $650
10	Anthem fee schedule · outpatient · +9 other terms	80	$243	$321	$290	90%	—	$126 – $1.7k
11	Kaiser fee schedule · outpatient · +7 other terms	64	$253	$459	$356	77%	—	$238 – $2.2k
12	Ambetter facility · fee schedule · outpatient · +7 other terms	46	$400	$419	$94	22%	—	$161 – $625
13	Superior Healthplan fee schedule · outpatient	40	$311	$311	$1	0%	—	$290 – $311
14	Clover fee schedule · outpatient · +3 other terms	37	$222	$243	$36	15%	—	$218 – $311
15	Oscar fee schedule · outpatient · +4 other terms	36	$290	$308	$83	27%	—	$233 – $503
16	Optum fee schedule · outpatient · +4 other terms	33	$238	$344	$183	53%	—	$214 – $740
17	Caresource fee schedule · outpatient · +5 other terms	28	$222	$238	$65	27%	—	$126 – $343
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$227	$210	$55	26%	—	$74 – $370
19	Regence facility · fee schedule · outpatient · +4 other terms	19	$257	$262	$10	4%	—	$246 – $282
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$267	$260	$13	5%	—	$227 – $267
21	Bcbs Tx fee schedule · outpatient	18	$290	$290	—	—	—	$290 – $290
22	Medicare fee schedule · outpatient · +3 other terms	18	$238	$239	$2	1%	—	$238 – $243
23	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$222	$257	$64	25%	—	$121 – $351
24	Highmark facility · fee schedule · outpatient · +4 other terms	14	$384	$380	$159	42%	—	$213 – $632
25	Tricare facility · fee schedule · outpatient · +2 other terms	14	$222	$223	$10	4%	—	$200 – $243

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