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Utah rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Facilitymedian $60 · 10th–90th $31–$1050%20%40%10th90th$60Professionalmedian $76 · 10th–90th $31–$5620%10%10th90th$76$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
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $57.54 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $60.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $75.86 / $100.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $104.71 / $104.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $117.49
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $131.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $107.15 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $64.57 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $47.86 / $85.11