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Knee Joints, Polycentric, Below-Knee

Utah rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Rates data updated July 2026.

Facilitymedian $398 · 10th–90th $191$5890%20%40%10th90th$398Professionalmedian $363 · 10th–90th $191$3,4670%10%10th90th$363$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$346.74
Typical High
$3,467.37
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$398.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$436.52
Typical High
$562.34
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$588.84
Typical High
$588.84
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$426.58
Typical High
$724.44
Select Health
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Select Health
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$602.56
Typical High
$660.69
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$602.56
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$398.11
Typical High
$467.74
United
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$295.12
Typical High
$457.09