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Utah rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $100 · 10th–90th $44–$1550%20%40%10th90th$100Professionalmedian $112 · 10th–90th $44–$6610%10%10th90th$112$50.0$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $81.28 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $114.82 / $147.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $154.88 / $154.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $112.20 / $169.82
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $154.88 / $158.49
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $158.49 / $186.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $69.18 / $114.82