Prosthetic leg addition: pelvic band 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/knee disartic pelvic band

Payers reporting HCPCS L5697

Payer pricing summary

Low

$34

Average

$137

Median

$117

High

$374

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +12 other terms	359	$101	$126	$74	59%	—	$47 – $876
2	UnitedHealthcare fee schedule · outpatient · +13 other terms	356	$100	$105	$33	31%	—	$34 – $435
3	Humana fee schedule · outpatient · +12 other terms	317	$102	$151	$159	105%	—	$55 – $756
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	218	$100	$143	$84	59%	—	$0 – $484
5	WellCare fee schedule · outpatient · +4 other terms	208	$101	$107	$18	16%	—	$96 – $192
6	Devoted fee schedule · outpatient · +3 other terms	165	$98	$100	$4	4%	—	$98 – $134
7	Molina fee schedule · outpatient · +5 other terms	138	$145	$144	$55	38%	—	$59 – $262
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$105	$101	$5	5%	—	$98 – $135
9	Cigna fee schedule · outpatient · +9 other terms	102	$103	$122	$39	32%	—	$96 – $336
10	Anthem fee schedule · outpatient · +6 other terms	80	$107	$151	$153	101%	—	$55 – $859
11	Kaiser fee schedule · outpatient · +6 other terms	64	$109	$202	$159	78%	—	$103 – $962
12	Ambetter facility · fee schedule · outpatient · +6 other terms	46	$186	$190	$40	21%	—	$83 – $276
13	Superior Healthplan fee schedule · outpatient	40	$103	$103	$0	0%	—	$96 – $103
14	Clover fee schedule · outpatient · +2 other terms	37	$98	$101	$6	6%	—	$96 – $131
15	Oscar fee schedule · outpatient · +4 other terms	36	$103	$121	$40	33%	—	$96 – $223
16	Optum fee schedule · outpatient · +2 other terms	33	$103	$132	$50	38%	—	$96 – $246
17	Caresource fee schedule · outpatient · +5 other terms	28	$98	$112	$38	34%	—	$55 – $177
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$117	$106	$27	25%	—	$38 – $164
19	Regence facility · fee schedule · outpatient · +4 other terms	19	$111	$114	$5	4%	—	$107 – $125
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$118	$116	$4	4%	—	$106 – $118
21	Bcbs Tx fee schedule · outpatient	18	$96	$96	—	—	—	$96 – $96
22	Medicare fee schedule · outpatient · +3 other terms	18	$103	$103	$1	1%	—	$103 – $105
23	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$115	$132	$33	25%	—	$62 – $181
24	Tricare facility · fee schedule · outpatient · +2 other terms	15	$103	$101	$4	4%	—	$88 – $105
25	Highmark facility · fee schedule · outpatient · +4 other terms	14	$170	$174	$72	41%	—	$98 – $295

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