Pelvic control belt for above-knee prosthesis at Fairview Maple Grove Surgery Center

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
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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

Maple Grove, MN

See all hospitals reporting HCPCS L5694 →

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $243 is about the same as the median hospital's median price ($246), higher than 48% of the 840 hospitals reporting HCPCS L5694. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L5694 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 22 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	Blue Cross Blue Shield federal fee schedule · outpatient	$187	$187	—	—	—	$187 – $187
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$190	$190	—	—	—	$190 – $190
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$190	$190	—	—	—	$190 – $190
4	Blue Cross Blue Shield federal fee schedule · both	$202	$202	—	—	—	$202 – $202
5	Blue Cross Blue Shield commercial fee schedule · both	$206	$206	—	—	—	$206 – $206
6	Medica accessability fee schedule · both	$213	$213	—	—	—	$213 – $213
7	Medica medicaid fee schedule · both	$213	$213	—	—	—	$213 – $213
8	Medica ma non-snp fee schedule · both	$231	$231	—	—	—	$231 – $231
9	Medica ma snp fee schedule · both	$231	$231	—	—	—	$231 – $231
10	Medica prime solution fee schedule · both	$231	$231	—	—	—	$231 – $231
11	Medica vantage fee schedule · both	$231	$231	—	—	—	$231 – $231
12	Blue Cross Blue Shield medicaid fee schedule · both	$232	$232	—	—	—	$232 – $232
13	Ucare mhcp fee schedule · both	$237	$237	—	—	—	$237 – $237
14	Cigna commercial fee schedule · both	$285	$285	$25	9%	—	$260 – $310
15	Ucare ifp with fairview fee schedule · outpatient	$383	$383	—	—	—	$383 – $383
16	Medica bold fee schedule · both	$401	$401	—	—	—	$401 – $401
17	Medica choice without / elect fee schedule · both	$445	$445	—	—	—	$445 – $445
18	Medica city of st paul / essential uplan fee schedule · both	$445	$445	—	—	—	$445 – $445
19	Medica choice with fee schedule · both	$461	$461	—	—	—	$461 – $461
20	UnitedHealthcare commercial fee schedule · both	$466	$466	—	—	—	$466 – $466
21	Ucare ifp fee schedule · outpatient	$510	$510	—	—	—	$510 – $510
22	Cigna commercial fee schedule · outpatient	$598	$598	$52	9%	—	$546 – $650

Last updated: May 18, 2026

Compare to other hospitals

See Pelvic control belt for above-knee prosthesis pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.