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Utah rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Facilitymedian $141 · 10th–90th $71–$2450%20%40%10th90th$141Professionalmedian $174 · 10th–90th $71–$1,2590%10%20%10th90th$174$50.0$100.0$200.0$500.0$1.0K

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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $128.82 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $141.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $177.83 / $229.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $245.47 / $245.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $275.42
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $295.12
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $245.47 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $144.54 / $162.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $194.98