Above-knee prosthetic pelvic control sleeve suspension addition

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 sleeve susp neoprene/equa

Payers reporting HCPCS L5695

Payer pricing summary

Low

$69

Average

$324

Median

$285

High

$760

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +17 other terms	370	$231	$237	$123	52%	—	$98 – $1.5k
2	Aetna fee schedule · outpatient · +16 other terms	361	$236	$264	$124	47%	—	$98 – $1.4k
3	Humana fee schedule · outpatient · +16 other terms	319	$233	$363	$435	120%	—	$104 – $2.0k
4	Blue Cross Blue Shield fee schedule · outpatient · +16 other terms	219	$261	$302	$164	54%	—	$0 – $1.3k
5	WellCare fee schedule · outpatient · +8 other terms	208	$250	$259	$47	18%	—	$193 – $453
6	Devoted fee schedule · outpatient · +4 other terms	165	$238	$249	$26	11%	—	$200 – $285
7	Molina fee schedule · outpatient · +12 other terms	140	$312	$344	$141	41%	—	$100 – $697
8	Cigna Healthspring fee schedule · outpatient · +3 other terms	116	$242	$253	$21	8%	—	$205 – $274
9	Cigna fee schedule · outpatient · +14 other terms	105	$238	$266	$135	51%	—	$149 – $1.6k
10	Anthem fee schedule · outpatient · +12 other terms	80	$238	$299	$258	86%	—	$113 – $1.5k
11	Kaiser fee schedule · outpatient · +12 other terms	64	$248	$360	$229	63%	—	$200 – $1.5k
12	Ambetter facility · fee schedule · outpatient · +6 other terms	47	$359	$386	$80	21%	—	$145 – $513
13	Caresource fee schedule · outpatient · +5 other terms	41	$205	$204	$47	23%	—	$112 – $309
14	Superior Healthplan fee schedule · outpatient	40	$280	$279	$1	0%	—	$261 – $280
15	Clover fee schedule · outpatient · +3 other terms	37	$228	$234	$25	11%	—	$205 – $280
16	Oscar fee schedule · outpatient · +6 other terms	36	$261	$279	$74	26%	—	$215 – $453
17	Optum fee schedule · outpatient · +4 other terms	33	$233	$319	$159	50%	—	$193 – $666
18	Medica facility · fee schedule · outpatient · +9 other terms	22	$204	$190	$51	27%	—	$67 – $333
19	Amerihealth Caritas fee schedule · outpatient · +2 other terms	18	$246	$243	$5	2%	—	$234 – $246
20	Bcbs Tx fee schedule · outpatient	18	$261	$261	—	—	—	$261 – $261
21	Medicare fee schedule · outpatient · +1 other terms	18	$233	$234	$2	1%	—	$233 – $238
22	Regence facility · fee schedule · outpatient · +7 other terms	17	$252	$238	$31	13%	—	$166 – $257
23	Tricare facility · fee schedule · outpatient · +5 other terms	17	$233	$230	$9	4%	—	$201 – $238
24	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$200	$231	$57	25%	—	$109 – $315
25	Bcbs Mn fee schedule · outpatient · +8 other terms	13	$182	$182	$42	23%	—	$88 – $213

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